Richard Kennedy

Primary specialty

PharmacistTaxonomy code 183500000X

License

041190 Issued in MO

Practice address

1025 Walton Dr
Fredericktown, MO 63645-7235

Phone

(573) 783-2663

Fax

(573) 783-8003

NPI assigned

Nov 8, 2020

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Wal-Mart Stores East LP

  • Community/Retail Pharmacy
  • Fredericktown, MO
  • NPI 1134146491
  NPD (past)
• Wal-Mart Stores East, LP

  • Pharmacy
  • Apollo Beach, FL
  • NPI 1437027208
  NPD (past)

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

{
    "created_epoch": "1604793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604793600000",
    "number": "1114528809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 WALTON DR",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636457235",
            "telephone_number": "573-783-2663",
            "fax_number": "573-783-8003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 WALTON DR",
            "city": "FREDERICKTOWN",
            "state": "MO",
            "postal_code": "636457235",
            "telephone_number": "573-783-2663",
            "fax_number": "573-783-8003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "RICHARD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-08",
        "last_updated": "2020-11-08",
        "certification_date": "2020-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "MO",
            "license": "041190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Konnor Mariah Jenkins, PHARM.D.
• Montana B Jensen, LMSW
• Amanda Jo Johnson, MPT
• Melissa Jordan, FNP
• Joshua Kemp
• Kevin G. Roberts D.C., P.C.
• Tanya Lynn Ann Kinkead, PLPC
• Kelsey Marie Kinneman, A-GNP-C
• Frank T Klima, APRN-BC
• Susan Lee Krydynski, OTR/L

• All providers in Fredericktown, MO
• Pharmacist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2020; 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.