MR. WILTON CRAIG KENNEDY (NPI# 1154475267) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154475267 |
| Entity Type | Individual |
| Full Name | MR. WILTON CRAIG KENNEDY |
| Credential | PA-C |
| Practice Address |
2620 Avenham Ave Sw Roanoke VA 24014-1507 |
| Practice Telephone | 5409854016 |
| Mailing Telephone | 5409854016 |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
0110 001184 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2620 AVENHAM AVE SW |
| City | ROANOKE |
| State | VA |
| Zip Code | 24014-1507 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417558602 | Irene Pace Seidman | Pharmacist | 3350 Clearbrook Village Ln, Roanoke, VA 24014 | 2020-11-04 |
| 1720617970 | Mounica Reddy Thootkur | Student in an Organized Health Care Education/Training Program | 2017 South Jefferson Street, 2nd Floor, Roanoke, VA 24014 | 2020-04-08 |
| 1326675422 | Bharath Muppala | Student in an Organized Health Care Education/Training Program | Carilion Roanoke Memorial Hospital, 1906 Belleview Ave, Roanoke, VA 24014 | 2020-03-26 |
| 1235629239 | Sanjeeb Sudarshan Bhandari | Student in an Organized Health Care Education/Training Program | 1906 Bellview Ave Se, Roanoke, VA 24014 | 2018-05-15 |
| 1104325778 | Vera J. Short | Registered Nurse | 3167 Huffman Ln, Roanoke, VA 24014 | 2018-02-08 |
| 1770001380 | Michael Alan Phillips I | Social Worker | 2017 Jefferson Street, Roanoke, VA 24014 | 2017-09-03 |
| 1306362884 | Sara Alicia Guasch | Student in an Organized Health Care Education/Training Program | Carilion Roanoke Memorial Hospital, 1906 Belleview Ave, Roanoke, VA 24014 | 2017-08-16 |
| 1790212256 | Pouya Mafi | Student in an Organized Health Care Education/Training Program | 1906 Belleview Ave, Carilion Roanoke Memorial Hospital, Roanoke, VA 24014 | 2017-05-16 |
| 1790222867 | Mara Cate | Physician Assistant | 523 Arbuttus Ave, Roanoke, VA 24014 | 2017-01-26 |
| 1508314634 | Dknl Enterprises, Inc. | Non-emergency Medical Transport (VAN) | 3629 Franklin Rd Sw Suite 205b, Roanoke, VA 24014 | 2016-09-19 |
| Find all providers in zip 24014 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144796749 | Rebecca Marie Swanson | Physician Assistant | 902 S Jefferson St Uppr Level, Roanoke, VA 24016-4404 | 2018-10-22 |
| 1760567481 | Jason Eric Bailey | Physician Assistant | 2110 Carolina Ave Sw Fl 3, Roanoke, VA 24014-1742 | 2006-10-25 |
| 1083626436 | Laura White | Physician Assistant | 2001 Crystal Spring Ave Sw Ste 201, Roanoke, VA 24014-2465 | 2006-08-13 |
| 1225099773 | Lucia Maria Kulhavy | Physician Assistant | 2013 Jefferson St Sw Fl 2, Roanoke, VA 24014-2419 | 2006-03-31 |
| 1386613164 | Sharon Anne Crookshanks | Physician Assistant | 4461 Starkey Rd Ste 201, Roanoke, VA 24018 | 2006-03-15 |
| 1306463906 | Christopher J Pucci | Physician Assistant | 101 Elm Ave Se, Roanoke, VA 24013-2222 | 2020-06-29 |
| 1275197980 | Rashadah Jordan | Physician Assistant | 5673 Airport Rd, Roanoke, VA 24012-1119 | 2019-04-29 |
| 1629561402 | Emily Marquina | Physician Assistant | 1906 Belleview Ave Se, Roanoke, VA 24014-1838 | 2018-06-07 |
| 1164930046 | Laura Buennemeyer | Physician Assistant | 3716 Melrose Ave Nw, Roanoke, VA 24017 | 2018-01-13 |
| 1104288679 | David Shrock | Physician Assistant | 1906 Belleview Ave Se, Roanoke, VA 24014-1838 | 2016-03-24 |
| Find all providers in ROANOKE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.