Individual provider Active NPI

Colin Kenny, CRNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Stroudsburg, PA
National Provider Identifier
1043066103
Registry record updated Apr 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
SP029627 Issued in PA
Practice address
1172 W Main St # B
Stroudsburg, PA 18360-1323
Phone
(570) 424-6187
NPI assigned
Apr 29, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X SP029627 PA Primary

Addresses

Primary practice location

1172 W Main St # B
Stroudsburg, PA 18360-1323

Mailing address

1172 W Main St # B
Stroudsburg, PA 18360-1323
Phone (570) 424-6187

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240524002749 PA Practitioner - Nurse Practitioner 9133561970 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
SP029627PAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Isl, LTD CurrentSince May 7, 2024 Accepting new patients

Locations

1172 W Main St
Stroudsburg, PA 18360
Phone (570) 424-6187

1172 W Main St
#B
Stroudsburg, PA 18360
Phone (570) 424-6187

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1714348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714348800000",
    "number": "1043066103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1172 W MAIN ST # B",
            "city": "STROUDSBURG",
            "state": "PA",
            "postal_code": "183601323",
            "telephone_number": "570-424-6187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1172 W MAIN ST # B",
            "city": "STROUDSBURG",
            "state": "PA",
            "postal_code": "183601323",
            "telephone_number": "570-424-6187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNY",
        "first_name": "COLIN",
        "credential": "CRNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-29",
        "last_updated": "2024-04-29",
        "certification_date": "2024-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SP029627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stroudsburg, PA

Sources for this page

Verify at the official NPI Registry.