Kenisha Shawnta Pemberton, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME117245 Issued in FL

Practice address

4430 Missouri Ave
Fort Leonard Wood, MO 65473-9098

Phone

(573) 596-0417

NPI assigned

Jun 8, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

Interoperability endpoints

• Direct secure messaging: kenisha.pemberton.2@29601.direct.athenahealth.com

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.

• Halifax Healthcare Systems Inc

  • Family Medicine Physician
  • Daytona Beach, FL
  • NPI 1245283530
  Medicare reassignment NPD
• United States Army

  • Military Hospital
  • Fort Leonard Wood, MO
  • NPI 1902263098
  NPD (past)
• Dwic of Tampa Bay, Inc

  • Urgent Care Clinic/Center
  • Hudson, FL
  • NPI 1598132490
  NPD (past)

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

{
    "created_epoch": "1339113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1114289907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ATTN: MCXP-DQS-CR",
            "address_2": "4430 MISSOURI AVENUE, BOX 1267",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "65473",
            "telephone_number": "573-596-0417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4430 MISSOURI AVE",
            "city": "FORT LEONARD WOOD",
            "state": "MO",
            "postal_code": "654739098",
            "telephone_number": "573-596-0417"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "237 Payne Pkwy Unit 101",
            "address_purpose": "LOCATION",
            "city": "Sarasota",
            "state": "FL",
            "postal_code": "342377018",
            "country_code": "US",
            "telephone_number": "941-893-2556",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEMBERTON",
        "first_name": "KENISHA",
        "middle_name": "SHAWNTA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-08",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME117245",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer H Parker
• Athina Patrick, APRN-CNP
• Kenneth A Paull, LCSW
• Tate Pearson, DMD
• Erica Jane Pelinski, P.A. - C
• Uriah Perez, ARNP
• Aren Wilhelm Peterson, DDS
• Melissa Ann Peterson, LISW, LCSW
• Pierre R. Pierce, D.D.S.
• Kristi Leigh Pitchford, LCSW

• Family Medicine Physician in Fort Leonard Wood, MO
• Providers in Fort Leonard Wood, MO by specialty
• Family Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.