Charlotte J Kennedy, MD PH D

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

100880 Issued in MO

Practice address

4921 Parkview PL Ste 5G
Saint Louis, MO 63110-1032

Phone

(314) 747-1970

Fax

(314) 747-1972

NPI assigned

Jul 26, 2006

Sex

Female

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

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Oct 1, 2019 through Oct 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Interoperability endpoints

• Direct secure messaging: ckennedy161737@direct.carenet.org

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574294400000",
    "number": "1235152588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4921 PARKVIEW PL STE 5G",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101032",
            "telephone_number": "314-747-1970",
            "fax_number": "314-747-1970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4921 PARKVIEW PL STE 5G",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101032",
            "telephone_number": "314-747-1970",
            "fax_number": "314-747-1972"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "CHARLOTTE",
        "middle_name": "J",
        "credential": "MD PH D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2019-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "100880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Adelina Kennedy-Delgado, MD
• Angela M Kennedy, PNP
• Anne Kennedy, PHARMD
• Annette T Kennedy, ACNP
• Catherine C Kennedy
• David G. Kennedy, M.D.
• Donald J Kennedy, MD
• Elaine Christine Kennedy, PNP
• Grace Ellen Kennedy, MD
• Harold Lloyd Kennedy, MD MPH

• Internal Medicine Physician in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.