Active NPI
Kimberly Aylene Kennedy, M. A.
- Clinical Psychologist
- Concord, NC
National Provider Identifier
1043334618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 1829
- Practice address
- 1065 Vinehaven Dr
Concord, NC 28025-2439 - Phone
- (704) 286-9181
- NPI assigned
- Mar 19, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1829 | NC | Primary |
Addresses
Primary practice location
1065 Vinehaven Dr
Concord, NC 28025-2439
Mailing address
PO Box 1886
Concord, NC 28026-6007
Phone (704) 436-6762
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1829 | NC | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043334618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1886",
"city": "CONCORD",
"state": "NC",
"postal_code": "280266007",
"telephone_number": "704-436-6762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1065 VINEHAVEN DR",
"city": "CONCORD",
"state": "NC",
"postal_code": "280252439",
"telephone_number": "704-286-9181"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "KIMBERLY",
"middle_name": "AYLENE",
"name_prefix": "Ms.",
"credential": "M. A.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "1829",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Concord, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.