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  5. PAMELA S. KENNEDY, MD, P.A.

PAMELA S. KENNEDY, MD, P.A.

Company Details

Entity Name: PAMELA S. KENNEDY, MD, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 12 Feb 2007 (18 years ago)
Document Number: P07000018813
FEI/EIN Number 208421681
Address: 1355 THOMASWOOD DR, TALLAHASSEE, FL, 32308
Mail Address: 1355 THOMASWOOD DR, TALLAHASSEE, FL, 32308
ZIP code: 32308
County: Leon
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1093098097 2011-09-26 2011-10-11 1355 THOMASWOOD DRIVE, TALLAHASSEE, FL, 32308, US 1355 THOMASWOOD DRIVE, TALLAHASSEE, FL, 32308, US

Contacts
Phone +1 850-656-4555

Authorized person
Name PAMELA KENNEDY
Role DERMATOLOGIST
Phone 8506564555

Taxonomy
Taxonomy Code 207N00000X - Dermatology Physician
License Number ME 84319
State FL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICARE ID
Number 15007
Issuer MEDICAID
Number 2807050-00
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
PAMELA S. KENNEDY, MD, P.A. 401(K) PROFIT SHARING PLAN 2023 208421681 2024-06-13 PAMELA S. KENNEDY, MD, P.A. 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 8506564555
Plan sponsor’s address 1355 THOMASWOOD DRIVE, TALLAHASSEE, FL, 32308

Signature of
Role Plan administrator
Date 2024-06-13
Name of individual signing PAMELA S. KENNEDY
Valid signature Filed with authorized/valid electronic signature
PAMELA S. KENNEDY, MD, P.A. 401(K) PROFIT SHARING PLAN 2022 208421681 2023-05-09 PAMELA S. KENNEDY, MD, P.A. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 8506564555
Plan sponsor’s address 1355 THOMASWOOD DRIVE, TALLAHASSEE, FL, 32308

Signature of
Role Plan administrator
Date 2023-05-09
Name of individual signing PAMELA S. KENNEDY
Valid signature Filed with authorized/valid electronic signature
PAMELA S. KENNEDY, MD, P.A. 401(K) PROFIT SHARING PLAN 2021 208421681 2022-06-17 PAMELA S. KENNEDY, MD, P.A. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 8506564555
Plan sponsor’s address 1355 THOMASWOOD DRIVE, TALLAHASSEE, FL, 32308

Signature of
Role Plan administrator
Date 2022-06-17
Name of individual signing PAMELA S. KENNEDY
Valid signature Filed with authorized/valid electronic signature
PAMELA S. KENNEDY, MD, P.A. 401(K) PROFIT SHARING PLAN 2020 208421681 2021-04-29 PAMELA S. KENNEDY, MD, P.A. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 8506564555
Plan sponsor’s address 1355 THOMASWOOD DRIVE, TALLAHASSEE, FL, 32308

Signature of
Role Plan administrator
Date 2021-04-29
Name of individual signing PAMELA S. KENNEDY
Valid signature Filed with authorized/valid electronic signature
PAMELA S. KENNEDY, MD, P.A. 401(K) PROFIT SHARING PLAN 2019 208421681 2020-09-21 PAMELA S. KENNEDY, MD, P.A. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 8506564555
Plan sponsor’s address 1355 THOMASWOOD DRIVE, TALLAHASSEE, FL, 32308

Signature of
Role Plan administrator
Date 2020-09-21
Name of individual signing PAMELA S. KENNEDY
Valid signature Filed with authorized/valid electronic signature
PAMELA S. KENNEDY, MD, P.A. 401(K) PROFIT SHARING PLAN 2018 208421681 2019-07-29 PAMELA S. KENNEDY, MD, P.A. 16
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 8506564555
Plan sponsor’s address 1355 THOMASWOOD DRIVE, TALLAHASSEE, FL, 323087915

Signature of
Role Plan administrator
Date 2019-07-29
Name of individual signing PAMELA S. KENNEDY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2019-07-29
Name of individual signing PAMELA S. KENNEDY
Valid signature Filed with authorized/valid electronic signature
PAMELA S. KENNEDY, MD, P.A. 401(K) PROFIT SHARING PLAN 2017 208421681 2018-09-11 PAMELA S. KENNEDY, MD, P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 8506564555
Plan sponsor’s address 1355 THOMASWOOD DRIVE, TALLAHASSEE, FL, 323087915

Signature of
Role Plan administrator
Date 2018-09-11
Name of individual signing PAMELA S. KENNEDY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2018-09-11
Name of individual signing PAMELA S. KENNEDY
Valid signature Filed with authorized/valid electronic signature
PAMELA S. KENNEDY, MD, P.A. 401(K) PROFIT SHARING PLAN 2016 208421681 2017-07-27 PAMELA S. KENNEDY, MD, P.A. 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 8506564555
Plan sponsor’s address 1355 THOMASWOOD DRIVE, TALLAHASSEE, FL, 323087915

Signature of
Role Plan administrator
Date 2017-07-27
Name of individual signing PAMELA S. KENNEDY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2017-07-27
Name of individual signing PAMELA S. KENNEDY
Valid signature Filed with authorized/valid electronic signature
PAMELA S. KENNEDY, MD, P.A. 401(K) PROFIT SHARING PLAN 2015 208421681 2016-07-28 PAMELA S. KENNEDY, MD, P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 8506564555
Plan sponsor’s address 1355 THOMASWOOD DRIVE, TALLAHASSEE, FL, 323087915

Signature of
Role Plan administrator
Date 2016-07-28
Name of individual signing PAMELA S. KENNEDY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2016-07-28
Name of individual signing PAMELA S. KENNEDY
Valid signature Filed with authorized/valid electronic signature
PAMELA S. KENNEDY, MD, P.A. 401(K) PROFIT SHARING PLAN 2014 208421681 2015-07-21 PAMELA S. KENNEDY, MD, P.A. 0
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2014-01-01
Business code 621111
Sponsor’s telephone number 8506564555
Plan sponsor’s address 1355 THOMASWOOD DRIVE, TALLAHASSEE, FL, 32308

Signature of
Role Plan administrator
Date 2015-07-21
Name of individual signing PAMELA S. KENNEDY
Valid signature Filed with authorized/valid electronic signature
Role Employer/plan sponsor
Date 2015-07-21
Name of individual signing PAMELA S. KENNEDY
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
KENNEDY PAMELA S Agent 1355 THOMASWOOD DR, TALLAHASSEE, FL, 32308

Director

Name Role Address
KENNEDY PAMELA S Director 1355 THOMASWOOD DR, TALLAHASSEE, FL, 32308

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2011-03-31 1355 THOMASWOOD DR, TALLAHASSEE, FL 32308 No data
CHANGE OF MAILING ADDRESS 2011-03-31 1355 THOMASWOOD DR, TALLAHASSEE, FL 32308 No data
REGISTERED AGENT ADDRESS CHANGED 2011-03-31 1355 THOMASWOOD DR, TALLAHASSEE, FL 32308 No data

Documents

Name Date
ANNUAL REPORT 2024-03-31
ANNUAL REPORT 2023-02-21
ANNUAL REPORT 2022-02-15
ANNUAL REPORT 2021-02-09
ANNUAL REPORT 2020-02-03
ANNUAL REPORT 2019-02-11
ANNUAL REPORT 2018-02-15
ANNUAL REPORT 2017-03-30
ANNUAL REPORT 2016-03-25
ANNUAL REPORT 2015-02-26

Related by officers

KENNEDY PAMELA S

PJLK, LLC

Related by address

No related companies by address

Date of last update: 01 Feb 2025

Sources: Florida Department of State

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