Kathleen S Renner, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Practice address

4201 Williamson PL
Mount Vernon, IL 62864-6740

Phone

(618) 244-5120

NPI assigned

Oct 19, 2006

Sex

Female

Sole proprietor

Yes

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

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1326120445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 WILLIAMSON PL",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646740",
            "telephone_number": "618-244-5120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 WILLIAMSON PL",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646740",
            "telephone_number": "618-244-5120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENNER",
        "first_name": "KATHLEEN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary M Reagan, MD
• Mary Christina Redden, MA, QMHP
• Vicki Renee Reich
• Renal Life Link Inc
• Rend Emergency Physicians
• Resilient Roots Therapy PLLC
• Samantha Reynolds
• Lynn Rheinecker, PHARM.D., R.PH.
• Natasha Carol Rhodes, AGNP-C
• Amy Lynn Richards

• General Practice Dentistry in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• General Practice Dentistry in Illinois

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.