Provider Demographics
NPI:1588160261
Name:KENNEDY, HANNAH ELISE (PA-C)
Entity type:Individual
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First Name:HANNAH
Middle Name:ELISE
Last Name:KENNEDY
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1 BERKSHIRE ESTATES CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-6305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1811 WILSHIRE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5626
Practice Address - Country:US
Practice Address - Phone:310-566-6330
Practice Address - Fax:310-566-6320
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2023-03-01
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Provider Licenses
StateLicense IDTaxonomies
CAPA55448363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant