Active NPI
Michael Arthur Kennedy, PA-C
- Medical Physician Assistant
- Pottsboro, TX
National Provider Identifier
1245391473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA04828
- Practice address
- 111 E Hwy 120
Ste. 104
Pottsboro, TX 75076-3008 - Phone
- (903) 786-3911
- NPI assigned
- Dec 12, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA04828 | TX | Primary |
Addresses
Primary practice location
111 E Hwy 120
Ste. 104
Pottsboro, TX 75076-3008
Mailing address
1038 Addison Ave
Pottsboro, TX 75076-7077
Phone (903) 786-8916
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 |
|---|---|---|---|
| PA04828 | TX | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235001600000",
"number": "1245391473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1038 ADDISON AVE",
"city": "POTTSBORO",
"state": "TX",
"postal_code": "750767077",
"telephone_number": "903-786-8916"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 E HWY 120",
"address_2": "STE. 104",
"city": "POTTSBORO",
"state": "TX",
"postal_code": "750763008",
"telephone_number": "903-786-3911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "MICHAEL",
"middle_name": "ARTHUR",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-12",
"last_updated": "2009-02-19",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA04828",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pottsboro, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.