Active NPI
Mackenzie Rose Kennedy, LAT, ATC
- Athletic Trainer
- Orlando, FL
National Provider Identifier
1134892334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AL6272
- Practice address
- 4000 Central Florida Blvd
Orlando, FL 32816-8005 - Phone
- (407) 823-2103
- NPI assigned
- Jul 26, 2021
- Last updated
- Jul 26, 2021
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AL6272 | FL | Primary |
Addresses
Primary practice location
4000 Central Florida Blvd
Orlando, FL 32816-8005
Mailing address
4180 N Orion Blvd
Orlando, FL 32816-8029
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 |
|---|---|---|---|
| AL6272 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627257600000",
"number": "1134892334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4180 N ORION BLVD",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328168029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4000 CENTRAL FLORIDA BLVD",
"city": "ORLANDO",
"state": "FL",
"postal_code": "328168005",
"telephone_number": "407-823-2103"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "MACKENZIE",
"middle_name": "ROSE",
"credential": "LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-07-26",
"last_updated": "2021-07-26",
"certification_date": "2021-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL6272",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orlando, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.