Active NPI
Randall Worley Kennedy, L.P.C.
- Professional Counselor
- Pampa, TX
National Provider Identifier
1245398262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 17266
- Practice address
- 1224 N Hobart St
Suite 1
Pampa, TX 79065-4606 - Phone
- (806) 688-0096
- Fax
- (806) 688-0096
- NPI assigned
- Dec 4, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 17266 | TX | Primary |
Addresses
Primary practice location
1224 N Hobart St
Suite 1
Pampa, TX 79065-4606
Mailing address
1308 Charles St
Pampa, TX 79065-4302
Phone (806) 688-0096
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 392019 | Other | TX | VALUEOPTIONS |
| 7224LC | Other | TX | BLUECROSS BLUE SHIELD |
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 |
|---|---|---|---|
| 17266 | TX | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245398262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1308 CHARLES ST",
"city": "PAMPA",
"state": "TX",
"postal_code": "790654302",
"telephone_number": "806-688-0096",
"fax_number": "806-688-0096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1224 N HOBART ST",
"address_2": "SUITE 1",
"city": "PAMPA",
"state": "TX",
"postal_code": "790654606",
"telephone_number": "806-688-0096",
"fax_number": "806-688-0096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "RANDALL",
"middle_name": "WORLEY",
"name_prefix": "Mr.",
"credential": "L.P.C.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "TX",
"license": "17266",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUEOPTIONS",
"identifier": "392019",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUE SHIELD",
"identifier": "7224LC",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pampa, TX
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.