Sofia Kenneally
Sofia Kenneally is a Physician Assistant in Lakeport, California. Qualified in 2021, 5 years ago. Practices with Providence Medical Foundation, a 1,465-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in California.
- Years since qualifying
- 5
- Licensed in
- CA
- In the registry since
- 2022
- Specialties on file
- 2
Practice location Address checks out
5176 Hill Rd ELakeport, CA 95453-6300
Phone: (707) 262-5000
Show map & directions
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Pin is approximate — placed at the ZIP-code centre, not the exact door.
Additional practice locations (1)
- 55 2nd St, San Francisco, CA 94105-3491 — (415) 600-0764
Specialties & licences
| Physician Assistant (primary) | Taxonomy 363A00000X · Licence PA60896 (CA) |
|---|---|
| Emergency Medicine Physician | Taxonomy 207P00000X · Licence 60896 (CA) |
Record details
| NPI number | 1528718327 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Sole proprietor | Yes |
| NPI enumerated | March 25, 2022 |
| Last updated in NPPES | October 24, 2025 |
| Certification date | October 24, 2025 |
| Mailing address | Po Box 2741, Petaluma, CA 94953-2741 |
Medicare enrollment
| Medicare specialty | PHYSICIAN ASSISTANT |
|---|---|
| Medical school | OTHER |
| Graduated | 2021 (5 years in practice) |
| Group practice | Providence Medical Foundation — 1465 clinicians |
| Accepts Medicare assignment | Yes — accepts the Medicare-approved amount |
| Telehealth | Offers telehealth services |
| Practice locations | 8 on file with Medicare |
Other providers in Lakeport
-
Farallon Inpatient Medical Group Inc
5176 Hill Rd E, Lakeport, CA 95453-6300 · (707) 262-5000
-
Edward M. Fedun, MD
5176 Hill Rd E, Lakeport, CA 95453-6300 · (707) 262-5000
-
Christian Hackshaw, MD
5176 Hill Rd E Emergency Dept, Lakeport, CA 95453-6300 · (707) 262-5050
-
Lakeport Emergency Medical Corporation
5176 Hill Rd E, Lakeport, CA 95453-6357 · (626) 447-0296