Active NPI
Krystal Kennedy
- Clinical Social Worker
- Virginia Beach, VA
National Provider Identifier
1134812118
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 0906010004
- Practice address
- 297 Independence Blvd
Pembroke 6, Suite 300
Virginia Beach, VA 23462 - Phone
- (757) 390-1736
- NPI assigned
- May 26, 2023
- 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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 0906010004 | VA | Primary |
Addresses
Primary practice location
297 Independence Blvd
Pembroke 6, Suite 300
Virginia Beach, VA 23462
Mailing address
297 Independence Blvd
Pembroke 6, Suite 300
Virginia Beach, VA 23462
Phone (757) 390-1736
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0906010004 | VA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| City of Virginia Beach | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Virginia Beach, VA
- NPI 1861562472
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1685059200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1685059200000",
"number": "1134812118",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "297 INDEPENDENCE BLVD",
"address_2": "PEMBROKE 6, SUITE 300",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "23462",
"telephone_number": "757-390-1736"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "297 INDEPENDENCE BLVD",
"address_2": "PEMBROKE 6, SUITE 300",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "23462",
"telephone_number": "757-390-1736"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "KRYSTAL",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-26",
"last_updated": "2023-05-26",
"certification_date": "2023-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "VA",
"license": "0906010004",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.