Active NPI
Karen J Kennedy, PA
- Medical Physician Assistant
- Lakeport, CA
National Provider Identifier
1326118365
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA15788
- Practice address
- 5335 Lakeshore Blvd
Lakeport, CA 95453-6123 - Phone
- (707) 263-7725
- Fax
- (707) 263-1096
- NPI assigned
- Nov 8, 2006
- Sex
- Female
- 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 | PA15788 | CA | Primary |
Addresses
Primary practice location
5335 Lakeshore Blvd
Lakeport, CA 95453-6123
Mailing address
5335 Lakeshore Blvd
Lakeport, CA 95453-6123
Phone (707) 263-7725
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA15788 | CA | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1326118365",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5335 LAKESHORE BLVD",
"city": "LAKEPORT",
"state": "CA",
"postal_code": "954536123",
"telephone_number": "707-263-7725",
"fax_number": "707-263-1096"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5335 LAKESHORE BLVD",
"city": "LAKEPORT",
"state": "CA",
"postal_code": "954536123",
"telephone_number": "707-263-7725",
"fax_number": "707-263-1096"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "KAREN",
"middle_name": "J",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "CA",
"license": "PA15788",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakeport, CA
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.