Most Relevant Information
Provider Data
| NPI Number: | 1003299082 |
| Provider Name: | MARY KATHERINE KENNEY PA |
| Entity Type: | Individual |
| Taxonomy Code: | 363AM0700X |
| Specialty: | Physician Assistant |
| License Number: | 085005526 |
Most Important Dates
| Enumeration Date: | 07/08/2015 |
| Last Updated: | 12/13/2023 |
Provider Practice Location
1800 E LAKE SHORE DR
DECATUR
IL
625213810
Practice Location Phone/Fax
| Phone: | 2174642966 |
| Fax: |
Provider Mailing Location
3131 N WATER ST
DECATUR
IL
625262472
Provider Mailing Phone/Fax
| Phone: | 2178765320 |
| Fax: | 2178765865 |