Provider Demographics
NPI:1962416909
Name:KENNEDY, JAY PEHRSON (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:PEHRSON
Last Name:KENNEDY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2200 SW GAGE BOULEVARD
Mailing Address - Street 2:U.S. DEPARTMENT OF VETERANS AFFAIRS
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66622-0000
Mailing Address - Country:US
Mailing Address - Phone:785-350-3111
Mailing Address - Fax:785-350-4496
Practice Address - Street 1:2200 SW GAGE BOULEVARD
Practice Address - Street 2:U.S. DEPARTMENT OF VETERANS AFFAIRS
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66622-0000
Practice Address - Country:US
Practice Address - Phone:785-350-3111
Practice Address - Fax:785-350-4496
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2014-10-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE22442207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSH83284Medicare UPIN