Individual provider Active NPI

Kennedy A King, DO

  • Family Medicine Physician
  • South Charleston, WV
National Provider Identifier
1114667540
Registry record updated Aug 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4737 Issued in WV
Practice address
506 Chestnut St
South Charleston, WV 25309-1204
Phone
(304) 766-8558
Fax
(304) 766-8561
NPI assigned
Apr 1, 2022
Last updated
Aug 13, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4737 WV Primary

Addresses

Primary practice location

506 Chestnut St
South Charleston, WV 25309-1204

Mailing address

506 Chestnut St
South Charleston, WV 25309-1204

Other practice location 1

3200 MacCorkle Ave SE Fl 5
Charleston, WV 25304-1297
Phone (304) 388-4600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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

Enrollment IDStateProvider typePAC IDDetails
I20251003000231 WV Practitioner - Family Practice 9133575871 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Pikeville, Kentucky College of Osteopathic Med, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
THS Physician Partners IncGroup PAC ID 9537316393, 366 clinicians

Practice addresses (Care Compare)

506 Chestnut St
South Charleston, WV 25309-1204
Phone (304) 766-8558

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
4737WVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
THS Physician Partners Inc Family Medicine CurrentSince Aug 15, 2025 Accepting new patients
Charleston Area Medical Center Inc PastSince Feb 1, 2024 Accepting new patients

Locations

L3539
Columbus, OH 43260
Phone (304) 414-4800

4605 Maccorkle Ave SW
South Charleston, WV 25309
Phone (304) 414-4800

506 Chestnut St
South Charleston, WV 25309
Phone (304) 766-8558

Interoperability endpoints

  • Direct secure messaging: kennedy.king.1@7363.direct.athenahealth.com

Organizations & group practices 2

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": "1648771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755043200000",
    "number": "1114667540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "506 CHESTNUT ST",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091204",
            "fax_number": "606-436-6988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "506 CHESTNUT ST",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091204",
            "telephone_number": "304-766-8558",
            "fax_number": "304-766-8561"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 MacCorkle Ave SE Fl 5",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "WV",
            "postal_code": "253041297",
            "country_code": "US",
            "telephone_number": "304-388-4600",
            "fax_number": "304-388-4603",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KING",
        "first_name": "KENNEDY",
        "middle_name": "A",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-01",
        "last_updated": "2025-08-13",
        "certification_date": "2025-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "4737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

Verify at the official NPI Registry.