Individual provider Active NPI

Kennedy S Wilkes, APRN

  • Nurse Practitioner
  • Savannah, TN
National Provider Identifier
1104790724
Registry record updated Oct 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
39985 Issued in TN
Practice address
60 Brazelton St Unit 6
Savannah, TN 38372-3080
Phone
(731) 438-3090
Fax
(731) 256-0757
NPI assigned
Oct 6, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 39985 TN Primary

Addresses

Primary practice location

60 Brazelton St Unit 6
Savannah, TN 38372-3080

Mailing address

PO Box 58
Savannah, TN 38372-0058
Phone (731) 438-3090

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20260216001845 TN Practitioner - Nurse Practitioner 0446757884 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Compassionate Care Clinic LLCGroup PAC ID 9830696269, 2 clinicians

Practice addresses (Care Compare)

60 Brazelton St
Savannah, TN 38372-3079
Phone (731) 438-3090

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
39985TNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Compassionate Care Clinic LLC CurrentSince Dec 8, 2025 Accepting new patients

Locations

60 Brazelton St
Savannah, TN 38372
Phone (731) 438-3090

60 Brazelton St
Unit 6
Savannah, TN 38372
Phone (731) 438-3090

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1759708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759708800000",
    "number": "1104790724",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 58",
            "city": "SAVANNAH",
            "state": "TN",
            "postal_code": "383720058",
            "telephone_number": "731-438-3090",
            "fax_number": "731-256-0757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 BRAZELTON ST UNIT 6",
            "city": "SAVANNAH",
            "state": "TN",
            "postal_code": "383723080",
            "telephone_number": "731-438-3090",
            "fax_number": "731-256-0757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKES",
        "first_name": "KENNEDY",
        "middle_name": "S",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-10-06",
        "last_updated": "2025-10-06",
        "certification_date": "2025-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "39985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, TN

Sources for this page

Verify at the official NPI Registry.