Active NPI
Kennedy Faith Wilbert, CYPS, OCPSA
- Prevention Professional
- Lorain, OH
National Provider Identifier
1033995972
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prevention Professional
- License
- OCPSA.161928
- Practice address
- 2115 W Park Dr
Lorain, OH 44053-1138 - Phone
- (440) 989-4900
- NPI assigned
- Sep 6, 2023
- Last updated
- Sep 6, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | YPS.000014 | OH | |
| Prevention Professional | 405300000X | OCPSA.161928 | OH | Primary |
Addresses
Primary practice location
2115 W Park Dr
Lorain, OH 44053-1138
Mailing address
2115 W Park Dr
Lorain, OH 44053-1138
Phone (440) 989-4900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| YPS.000014 | OH | MD | Peer Specialist |
| OCPSA.161928 | OH | MD | Prevention Professional |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1693958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1693958400000",
"number": "1033995972",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2115 W PARK DR",
"city": "LORAIN",
"state": "OH",
"postal_code": "440531138",
"telephone_number": "440-989-4900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2115 W PARK DR",
"city": "LORAIN",
"state": "OH",
"postal_code": "440531138",
"telephone_number": "440-989-4900"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILBERT",
"first_name": "KENNEDY",
"middle_name": "FAITH",
"credential": "CYPS, OCPSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-09-06",
"last_updated": "2023-09-06",
"certification_date": "2023-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OH",
"license": "YPS.000014",
"primary": false
},
{
"code": "405300000X",
"taxonomy_group": "",
"desc": "Prevention Professional",
"state": "OH",
"license": "OCPSA.161928",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lorain, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.