Individual provider Active NPI

Whitney Kennedy, RN

  • Home Health Registered Nurse
  • South Charleston, WV
National Provider Identifier
1053096511
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health Registered NurseTaxonomy code 163WH0200X
License
91802 Issued in WV
Practice address
4825 Maccorkle Ave SW Ste F
South Charleston, WV 25309-1365
Phone
(304) 346-9667
Fax
(304) 346-9717
NPI assigned
Jun 21, 2023
Last updated
Jun 21, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Registered Nurse 163WH0200X 91802 WV Primary

Addresses

Primary practice location

4825 Maccorkle Ave SW Ste F
South Charleston, WV 25309-1365

Mailing address

4825 Maccorkle Ave SW Ste F
South Charleston, WV 25309-1365
Phone (304) 346-9667

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
Registered Nurse

State licenses

LicenseStateTypeSpecialty
91802WVMDHome Health Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Centerwell Certified Healthcare Corp. CurrentSince Jun 25, 2023 Accepting new patients
Centerwell Certified Healthcare Corp PastSince Jun 25, 2023 Accepting new patients

Locations

4825 Maccorkle Ave SW
Ste F
South Charleston, WV 25309
Phone (304) 346-9667

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1687305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1053096511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4825 MACCORKLE AVE SW STE F",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091365",
            "telephone_number": "304-346-9667",
            "fax_number": "304-346-9717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4825 MACCORKLE AVE SW STE F",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091365",
            "telephone_number": "304-346-9667",
            "fax_number": "304-346-9717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "WHITNEY",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-21",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WH0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Home Health",
            "state": "WV",
            "license": "91802",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.

Verify at the official NPI Registry.