NPIMap

Individual provider Active NPI

Kendra Kay Hackney, FNP

  • Family Nurse Practitioner
  • McKinleyville, CA
National Provider Identifier
1053612697
Registry record updated Aug 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95027800 Issued in CA
Practice address
1644 Central Ave
McKinleyville, CA 95519-4342
Phone
(707) 839-3068
Fax
(707) 839-3827
NPI assigned
Nov 13, 2010
Sex
Female
Sole proprietor
No

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Open Door Community Health Centers 113 clinicians

Practice addresses (Care Compare)

1644 Central Ave
McKinleyville, CA 95519-4342
Phone (707) 839-3068

2200 Tydd St
Eureka, CA 95501-1284
Phone (707) 441-1624

Hospital & facility affiliations

  • Providence at Home With Compassus Home Health, Humboldt Home health agency, Eureka, CA, CCN 057256
  • Mad River Community Hospital Hospital, Arcata, CA, CCN 050028
  • Providence St Joseph Hospital Hospital, Eureka, CA, CCN 050006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110408000689 MN Practitioner - Nurse Practitioner 8820272230 Reassigns benefits to 1 organization
I20240319000810 CA Practitioner - Nurse Practitioner 8820272230 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CNP2597MNMDFamily Nurse Practitioner
F0910261MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lifecare Medical Center Current Accepting new patients
Open Door Community Health Centers CurrentSince Jan 20, 2024 Accepting new patients
Open Door Community Health Centers CurrentSince Jan 20, 2024 Accepting new patients
Open Door Community Health Centers Current Accepting new patients

Locations

1275 8th St
Arcata, CA 95521

1644 Central Ave
McKinleyville, CA 95519
Phone (707) 839-3068

412 Main Ave NE
Warroad, MN 56763
Phone (218) 386-2020

Interoperability endpoints

  • Direct secure messaging: khackney683225@direct.ochin.org

Specialties & licenses 4

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95027800 CA Primary
General Practice Registered Nurse 163WG0000X 95354760 CA
Family Nurse Practitioner 363LF0000X F0910261 MN
Family Nurse Practitioner 363LF0000X CNP2597 MN

Addresses

NPPES NPI Registry

Primary practice location

1644 Central Ave
McKinleyville, CA 95519-4342

Mailing address

1275 8TH St
Arcata, CA 95521-5770
Phone (707) 826-8633

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 29, 2024.

{
    "created_epoch": "1289606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724889600000",
    "number": "1053612697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 8TH ST",
            "city": "ARCATA",
            "state": "CA",
            "postal_code": "955215770",
            "telephone_number": "707-826-8633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1644 CENTRAL AVE",
            "city": "MCKINLEYVILLE",
            "state": "CA",
            "postal_code": "955194342",
            "telephone_number": "707-839-3068",
            "fax_number": "707-839-3827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKNEY",
        "first_name": "KENDRA",
        "middle_name": "KAY",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-13",
        "last_updated": "2024-08-29",
        "certification_date": "2024-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95027800",
            "primary": true
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "CA",
            "license": "95354760",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "F0910261",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "CNP2597",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McKinleyville, CA

Sources for this page

Verify at the official NPI Registry.