Active NPI
Tina Kennimer, NP
- Family Nurse Practitioner
- Kennedale, TX
National Provider Identifier
1114549185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP146035
- Practice address
- 1115 Kennedale Sublett Rd
Kennedale, TX 76060-5821 - Phone
- (682) 429-2723
- NPI assigned
- May 13, 2020
- Last updated
- May 13, 2020
- 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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP146035 | TX | Primary |
Addresses
Primary practice location
1115 Kennedale Sublett Rd
Kennedale, TX 76060-5821
Mailing address
1115 Kennedale Sublett Rd
Kennedale, TX 76060-5821
Phone (682) 429-2723
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
9304 Forest LN
Suite S145
Dallas, TX 75243-6238
Phone (469) 809-4979
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
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.
-
- Clinic/Center
- Dallas, TX
- NPI 1124995279
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1589328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589328000000",
"number": "1114549185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1115 KENNEDALE SUBLETT RD",
"city": "KENNEDALE",
"state": "TX",
"postal_code": "760605821",
"telephone_number": "682-429-2723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1115 KENNEDALE SUBLETT RD",
"city": "KENNEDALE",
"state": "TX",
"postal_code": "760605821",
"telephone_number": "682-429-2723"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNIMER",
"first_name": "TINA",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-13",
"last_updated": "2020-05-13",
"certification_date": "2020-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "TX",
"license": "AP146035",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennedale, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2020; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.