MATTHEW M KENICK (NPI# 1922051614) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922051614 |
| Entity Type | Individual |
| Full Name | MATTHEW M KENICK |
| Credential | PAC |
| Practice Address |
1625 Se 3rd Avenue Third Floor Fort Lauderdale FL 33316 |
| Mailing Address |
1700 Nw 49th Street Suite 125 Fort Lauderdale FL 33309-3763 |
| Practice Telephone | 9543554665 |
| Practice Fax Number | 9543554881 |
| Mailing Telephone | (954) 355-4665 |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2017-08-31 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA3593 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 290516700 | 05 |
| Street Address |
1625 SE 3RD AVENUE THIRD FLOOR |
| City | FORT LAUDERDALE |
| State | FL |
| Zip Code | 33316 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194728964 | Celso Agner | Psychiatry & Neurology | 1625 Se 3rd Avenue, Suite 623, Fort Lauderdale, FL 33316-2521 | 2005-05-24 |
| 1164884235 | North Broward Hospital District | Pediatrics | 1625 Se 3rd Avenue, Suite 635, Fort Lauderdale, FL 33316-2521 | 2016-03-28 |
| 1114366580 | North Broward Hospital District | Internal Medicine | 1625 Se 3rd Avenue, Suite 623, Fort Lauderdale, FL 33316-2521 | 2013-06-19 |
| 1962561647 | Michelle Grace Binns | Internal Medicine | 1625 Se 3rd Avenue, Suite 400, Fort Lauderdale, FL 33316-2521 | 2006-12-08 |
| 1376500645 | Pamela M Sutton | Family Medicine | 1625 Se 3rd Avenue, Suite 525, Fort Lauderdale, FL 33316 | 2006-04-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366064040 | Jonathan David Ortiz | Behavior Technician | 1717 Se 4 Ave, Fort Lauderdale, FL 33316 | 2020-05-15 |
| 1306311626 | Gateway Recovery Center, LLC | Counselor | 1421 Sw 4th Avenue, Suite B, Fort Lauderdale, FL 33316 | 2018-10-13 |
| 1588141626 | Natan Bastoky | Family Medicine | 1600 S Andrews Ave # Gme, Fort Lauderdale, FL 33316 | 2018-07-22 |
| 1104320126 | Kathleen Kanani Graham | Pharmacist | 1401 S. Federal Highway, Ft. Lauderdale, FL 33316 | 2018-03-23 |
| 1093224271 | Lacosta Therapy, LLC | Behavioral Analyst | 412 Se 15 St., #4, Ft. Lauderdale, FL 33316 | 2017-09-20 |
| 1124560370 | Yulia Rybalka | Pharmacist | 217 Se 10th Street, Ft Lauderdale, FL 33316 | 2016-11-04 |
| 1730635376 | Brian Alexander Reyes | Specialist/Technologist | 303 Se 3rd Ave, Ft Lauderdale, FL 33316 | 2016-09-01 |
| 1649726282 | Jennifer Tabares | Specialist/Technologist | 303 Southeast 3rd Av, Fort Lauderdale, FL 33316 | 2016-09-01 |
| 1609236850 | Diane Nicole Shilling | Nurse Practitioner | 1001 South Andrews Avenue, Suite 100, Ft. Lauderdale, FL 33316 | 2016-03-01 |
| 1396113239 | Victoria Rosado | Adult Companion | 150 Se 12th Street, 401(b), Fort Lauderdale, FL 33316 | 2015-09-09 |
| Find all providers in zip 33316 | ||||
| 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 |
|---|---|---|---|---|
| 1124654538 | Joanna Gasdogas | Physician Assistant | 6451 N Federal Hwy Ste 700, Fort Lauderdale, FL 33308-1420 | 2020-03-17 |
| 1487299178 | Johanne Louis | Physician Assistant | 730 Nw 19th St Apt West, Fort Lauderdale, FL 33311-4006 | 2019-11-17 |
| 1013551266 | Tito Velasquez | Physician Assistant | 1160 N Federal Hwy Apt 1023, Fort Lauderdale, FL 33304-1436 | 2019-10-31 |
| 1275001406 | Michael Louis Alexander Jr. | Physician Assistant | 1940 Ne 47th St Ste 1, Fort Lauderdale, FL 33308-7711 | 2018-11-06 |
| 1972088706 | Kayla Lynn Ventura | Physician Assistant | 4801 N Federal Hwy Ste 101, Fort Lauderdale, FL 33308-4618 | 2018-09-27 |
| 1528557394 | Allied Health Provider LLC | Physician Assistant | 1625 Ne 3rd Ct, Fort Lauderdale, FL 33301-3808 | 2018-05-07 |
| 1396246005 | Marissa Amina Kazim | Physician Assistant | 3465 Galt Ocean Dr Ste 101, Fort Lauderdale, FL 33308-7077 | 2018-02-27 |
| 1306356886 | Jennifer Ashley Alexander | Physician Assistant | 4701 N Federal Hwy Ste A39, Fort Lauderdale, FL 33308-4608 | 2017-10-10 |
| 1366842585 | Hannah Silverman | Physician Assistant | 4800 Ne 20th Ter Ste 115, Fort Lauderdale, FL 33308-4510 | 2014-08-25 |
| 1811240518 | Angela Kakaley Hall | Physician Assistant | 900 Ne 26th Ave, Fort Lauderdale, FL 33304-3607 | 2012-10-18 |
| Find all providers in FORT LAUDERDALE | ||||
| City | FORT LAUDERDALE |
| Zip Code | 33316 |
Please comment or provide details below to improve the information on MATTHEW M KENICK.
| 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.