Tracie Kenyon

Primary specialty

Pharmacotherapy PharmacistTaxonomy code 1835P1200X

License

5302025428 Issued in MI

Practice address

3883 E Grand River Ave
Howell, MI 48843-8564

Phone

(517) 552-6610

Fax

(517) 552-6665

NPI assigned

May 1, 2014

Last updated

May 1, 2014By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1398902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398902400000",
    "number": "1285044081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11619 RIDGE RD",
            "city": "SOUTH LYON",
            "state": "MI",
            "postal_code": "481789319",
            "telephone_number": "517-552-6610",
            "fax_number": "517-552-6665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3883 E GRAND RIVER AVE",
            "city": "HOWELL",
            "state": "MI",
            "postal_code": "488438564",
            "telephone_number": "517-552-6610",
            "fax_number": "517-552-6665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENYON",
        "first_name": "TRACIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-05-01",
        "last_updated": "2014-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1835P1200X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacotherapy",
            "state": "MI",
            "license": "5302025428",
            "primary": true
        },
        {
            "code": "1835P1200X",
            "taxonomy_group": "",
            "desc": "Pharmacist, Pharmacotherapy",
            "state": "FL",
            "license": "PS39138",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST-PHARMACOTHERAPY",
            "identifier": "1835P1200X",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles E Kelly, D.O.
• Robert Michael Kempisty, LMSW.
• Ken Rakowicz DC PC (Cornerstone Family Chiropractic)
• Beth Joan Kennedy, MSW, LMSW
• Anne Elizabeth Kenney, NURSE PRACTITIONER
• Shannon Kathleen Keranen, MT
• Monica Lee Kerner, MACCC-SLP
• Pamela Christine Ketchel, CMT
• Freddy Keys
• Nick P Kiessel

• Pharmacotherapy Pharmacist in Howell, MI
• Providers in Howell, MI by specialty
• Pharmacotherapy Pharmacist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.