Active NPI
Tyler Kennedy, PHARM D
- Pharmacist
- Park Falls, WI
National Provider Identifier
1346851425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 19551-40
- Practice address
- 138 2ND Ave N
Park Falls, WI 54552-1299 - Phone
- (715) 762-3283
- NPI assigned
- Aug 12, 2020
- 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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 19551-40 | WI | Primary |
Addresses
Primary practice location
138 2ND Ave N
Park Falls, WI 54552-1299
Mailing address
N15588 Wagner Rd
Park Falls, WI 54552-8259
Phone (715) 661-3262
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19551-40 | WI | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597190400000",
"number": "1346851425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N15588 WAGNER RD",
"city": "PARK FALLS",
"state": "WI",
"postal_code": "545528259",
"telephone_number": "715-661-3262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "138 2ND AVE N",
"city": "PARK FALLS",
"state": "WI",
"postal_code": "545521299",
"telephone_number": "715-762-3283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "TYLER",
"credential": "PHARM D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-12",
"last_updated": "2020-08-12",
"certification_date": "2020-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WI",
"license": "19551-40",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park Falls, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.