Provider Demographics
NPI:1518462290
Name:PRENTICE, KENAN STEWART (PA-C)
Entity type:Individual
Prefix:
First Name:KENAN
Middle Name:STEWART
Last Name:PRENTICE
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Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:PO BOX 95590
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-0590
Mailing Address - Country:US
Mailing Address - Phone:801-352-9500
Mailing Address - Fax:801-352-7976
Practice Address - Street 1:125 BAPTIST WAY STE 4C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2274
Practice Address - Country:US
Practice Address - Phone:448-227-6330
Practice Address - Fax:850-626-9606
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2025-08-20
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant