Wilton Craig Kennedy, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

0110 001184 Issued in VA

Practice address

2620 Avenham Ave SW
Roanoke, VA 24014-1507

Phone

(540) 985-4016

NPI assigned

Jan 23, 2007

Sex

Male

Sole proprietor

No

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

Enrolled in VA, NC, DC3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Specialty

Physician Assistant

Education

Emory University School of Medicine, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Roanoke Valley Healthcare Partners LLCGroup PAC ID 0143490326, 53 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Roanoke Valley Healthcare Partners, LLC

  • Multi-Specialty Clinic/Center
  • Roanoke, VA
  • NPI 1619274446

  DC

  Medicare reassignment Care Compare group
• DRX High Point, PLLC

  • Multi-Specialty Clinic/Center
  • High Point, NC
  • NPI 1669701306
  Medicare reassignment
• Blue Ridge Healthcare Partners, LLC

  • Primary Care Clinic/Center
  • Roanoke, VA
  • NPI 1518304955
  NPD (past)

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1154475267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 AVENHAM AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240141507",
            "telephone_number": "540-985-4016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 AVENHAM AVE SW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240141507",
            "telephone_number": "540-985-4016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "WILTON",
        "middle_name": "CRAIG",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110 001184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole D. Kemp, APRN
• Tyler Bryce Kemp, PA-C
• Jaclyn Christine Kempf
• Brittany Ann Kendrick, FNP-C
• William Kennebeck, DC
• Patrick William Kenney, NP
• Taryn Nicole Kenney, PA
• Eileen C Kenny, MD
• Elizabeth Claire Kent, CCC-SLP
• Grace Ellen Kent, LCSW

• Medical Physician Assistant in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Medical Physician Assistant in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.