MR. KEVIN WALTER WENNER (NPI# 1831687300) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831687300 |
| Entity Type | Individual |
| Full Name | MR. KEVIN WALTER WENNER |
| Credential | PA-C |
| Practice Address |
319 Longwood Ave Boston MA 02115-5728 |
| Mailing Address |
18 Fox Run Dr Pittsgrove NJ 08318-4603 |
| Practice Telephone | 6173553501 |
| Mailing Telephone | 8563816891 |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2018-04-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA6455 | MA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
PA6455 | MA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA6455 | MA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
319 LONGWOOD AVE |
| City | BOSTON |
| State | MA |
| Zip Code | 02115-5728 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326040080 | Gary P Kearney | Urology | 319 Longwood Ave, Boston, MA 02115-5728 | 2005-08-12 |
| 1124518329 | Brianna Quintiliani | Physician Assistant | 319 Longwood Ave, Boston, MA 02115 | 2018-05-14 |
| 1740723139 | Shannon Savage | Physician Assistant | 319 Longwood Ave, Boston, MA 02115-5728 | 2016-12-02 |
| 1336591023 | Meghan Leigh Keating | Physician Assistant | 319 Longwood Ave, Floor Six, Boston, MA 02115-5728 | 2016-07-06 |
| 1528418001 | Mary Mihovan | Nurse Practitioner | 319 Longwood Ave, Boston, MA 02115-5728 | 2016-06-15 |
| 1386014173 | Jacqueline Hastings | Nurse Practitioner | 319 Longwood Ave, 6th Floor Sports Medicine, Boston, MA 02115-5728 | 2015-10-06 |
| 1205243078 | Agnieszka Kowalczyk | Pediatrics | 319 Longwood Ave, Boston, MA 02115-5728 | 2014-07-14 |
| 1093121055 | Emily Hanson | Specialist/Technologist | 319 Longwood Ave, Boston, MA 02115-5728 | 2014-07-10 |
| 1053743245 | Rachel Stephanie Shade | Psychologist | 319 Longwood Ave, Boston, MA 02115-5728 | 2013-07-30 |
| 1013261775 | Lua Associates PC | Urology | 319 Longwood Ave, Boston, MA 02115-5728 | 2012-11-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013524339 | Jacqueline Busa | Student in an Organized Health Care Education/Training Program | Northeastern University 336 Huntington Ave, Boston, MA 02115 | 2020-09-30 |
| 1417564279 | Katherine Rose Brainard | Student in an Organized Health Care Education/Training Program | 336 Huntington Avenue, Boston, MA 02115 | 2020-09-25 |
| 1679189112 | Tara Baxter | Orthopaedic Surgery | Boston Children's Hospital - Sports Medicine Division, 319 Longwood Avenue, Boston, MA 02115 | 2020-09-21 |
| 1053923110 | Wendy Tu | Student in an Organized Health Care Education/Training Program | 75 Francis Street Abdominal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115 | 2020-08-20 |
| 1477177335 | Nicolas Wyvekens | Student in an Organized Health Care Education/Training Program | 75 Francis Street Department of Pathology, Brigham And, Boston, MA 02115 | 2020-06-05 |
| 1669095923 | Erin Crocker | Student in an Organized Health Care Education/Training Program | Northeastern University Physician Assistant Program, 360 Huntington Avenue, Boston, MA 02115 | 2020-05-21 |
| 1033732417 | Tyler Francis Hayes | Student in an Organized Health Care Education/Training Program | Gordon Hall, Suite 213, 25 Shattuck Street, Boston, MA 02115 | 2020-05-20 |
| 1982225090 | Emily Blake | Student in an Organized Health Care Education/Training Program | 202 Robinson Hall, 360 Huntington Avenue, Boston, MA 02115 | 2020-04-29 |
| 1891315495 | Stephanie Schoch | Student in an Organized Health Care Education/Training Program | 360 Huntington Ave., 202 Robinson Hall, Boston, MA 02115 | 2020-04-23 |
| 1427678093 | Meghan Miles | Student in an Organized Health Care Education/Training Program | 360 Huntington Avenue 202 Robinson Hall, Boston, MA 02115 | 2020-04-23 |
| Find all providers in zip 02115 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205435393 | Allison Lee Nocon | Physician Assistant | 289 Beacon St Apt 8, Boston, MA 02116-1263 | 2020-10-20 |
| 1336746775 | Lee T Gernon-lakin | Physician Assistant | 202 Robinson Hall, 360 Huntington Ave, Boston, MA 02215 | 2020-10-08 |
| 1639781230 | Amanda Mae Saxton | Physician Assistant | 1410 Columbia Rd Apt 8g, Boston, MA 02127-4016 | 2020-08-17 |
| 1336757137 | Sabrina J Jamiel | Physician Assistant | 144 Calumet St Apt 3, Boston, MA 02120-3378 | 2020-07-17 |
| 1811505969 | Matthew George Cronin | Physician Assistant | 105 Landseer St, Boston, MA 02132-3436 | 2020-07-15 |
| 1902420284 | Rebecca Lee | Physician Assistant | 89 Chester St Apt A5, Boston, MA 02134-2219 | 2020-06-03 |
| 1982239430 | Catherine Dam | Physician Assistant | 357 Commercial St Apt 420, Boston, MA 02109-1236 | 2020-03-05 |
| 1033742390 | Melissa Stathas | Physician Assistant | 32 Fruit St Bldg 5th, Boston, MA 02114-2620 | 2020-02-14 |
| 1831740448 | Jennifer Hughes | Physician Assistant | 55 Fruit Street, Founders 110, Boston, MA 02114 | 2019-09-25 |
| 1275184905 | Danielle Dacunha | Physician Assistant | 42 Worcester Sq Apt 10, Boston, MA 02118-2920 | 2019-09-24 |
| Find all providers in BOSTON | ||||
Please comment or provide details below to improve the information on MR. KEVIN WALTER WENNER.
| 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.