Kristi Nicole Johnson Kennedy, DDS, MPH

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

29922 Issued in TX

Practice address

310 W Losey St
Scott Afb, IL 62225-5250

Phone

(618) 256-2833

NPI assigned

Aug 14, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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": "1407974400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782172800000",
    "number": "1376942573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 W LOSEY ST",
            "city": "SCOTT AFB",
            "state": "IL",
            "postal_code": "622255250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 W LOSEY ST",
            "city": "SCOTT AFB",
            "state": "IL",
            "postal_code": "622255250",
            "telephone_number": "618-256-2833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "KRISTI",
        "middle_name": "NICOLE JOHNSON",
        "credential": "DDS, MPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-14",
        "last_updated": "2026-06-23",
        "certification_date": "2026-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "29922",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "29922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jill Kinsella DMD LLC
• Loren Mark Johnson, M.D.
• Mark D. Johnson, OD
• Cheryl D Jones, RN
• Neil L Jorgensen, MD
• Halifax C King, M.D.
• Jill Anne Kinsella, DMD
• Richard C Kipp, MD
• Patrick Christopher Korthuis, IDMT
• Patsy Frances Kremsreiter, MD

• All providers in Scott Afb, IL
• Periodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2026; 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.