Kenneth Jay Headen, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

9400266 Issued in NC

Practice address

806 Summit Ave
Greensboro, NC 27405-7861

Phone

(336) 437-2354

Fax

(336) 279-1226

NPI assigned

May 4, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Burlington Psychiatry & Assoc

  • Medical Specialty Clinic/Center
  • Burlington, NC
  • NPI 1598053399
  NPD (past) Authorized official
• Burlington Psychiatry & Assoc. Inc

  • Mental Health Counselor
  • Burlington, NC
  • NPI 1588846109
  NPD (past) Authorized official
• 1St Choice Health Services LLC

  • Community/Behavioral Health Agency
  • Greensboro, NC
  • NPI 1225494545
  NPD (past)
• Alamance Caswell Area MH DD Sa Area Authority

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Burlington, NC
  • NPI 1023131711
  NPD (past)
• Mindpath Care Centers, North Carolina, PLLC

  dba Mindpath Health, a practice of, MindPath Care Centers, North Carolina,

  • Psychiatry Physician
  • Durham, NC
  • NPI 1508803214
  NPD (past)
• Rockingham Family Health, Psychological & Counseling Center, PLLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Reidsville, NC
  • NPI 1760671754
  NPD (past)

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435536000000",
    "number": "1366654329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 SUMMIT AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274057861",
            "telephone_number": "336-437-2354",
            "fax_number": "336-279-1226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 SUMMIT AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274057861",
            "telephone_number": "336-437-2354",
            "fax_number": "336-279-1226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEADEN",
        "first_name": "KENNETH",
        "middle_name": "JAY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-04",
        "last_updated": "2015-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NC",
            "license": "9400266",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5917028",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• HCP Greensboro NC Opco, LLC (Brighton Gardens of Greensboro)
• Head and Heart Counseling, PLLC
• Barbara Slovak Head, LPA
• Headache Wellness Center PC
• Headache Wellness Center PC (EMG EEG Consultants)
• Heag Pain Management Center PA
• Heag Pain Management Center PA
• Heag Pain Management Center PA
• Heag Pain Management Center PA
• Heag Pain Management Center, PA

• Psychiatry Physician in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Psychiatry Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2015; 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.