Active NPI
Andra R Kennedy, PA
- Physician Assistant
- Johnston, IA
National Provider Identifier
1083674097
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 648
- Practice address
- 5900 NW 86TH St
Suite 100
Johnston, IA 50131-2284 - Phone
- (515) 276-6133
- Fax
- (515) 334-7356
- NPI assigned
- Mar 24, 2006
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 648 | IA | Primary |
Addresses
Primary practice location
5900 NW 86TH St
Suite 100
Johnston, IA 50131-2284
Mailing address
5900 NW 86TH St
Suite 100
Johnston, IA 50131-2284
Phone (515) 276-6133
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 648 | IA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192492800000",
"number": "1083674097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5900 NW 86TH ST",
"address_2": "SUITE 100",
"city": "JOHNSTON",
"state": "IA",
"postal_code": "501312284",
"telephone_number": "515-276-6133",
"fax_number": "515-334-7356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5900 NW 86TH ST",
"address_2": "SUITE 100",
"city": "JOHNSTON",
"state": "IA",
"postal_code": "501312284",
"telephone_number": "515-276-6133",
"fax_number": "515-334-7356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "ANDRA",
"middle_name": "R",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-24",
"last_updated": "2007-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IA",
"license": "648",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Johnston, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 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.