Active NPI
Jessica Kenneson, RN
- Pediatric Registered Nurse
- Wylie, TX
National Provider Identifier
1407415805
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Registered Nurse
- License
- 968529
- Practice address
- 3603 Barberry Dr
Wylie, TX 75098-8557 - Phone
- (469) 386-4484
- NPI assigned
- Jun 10, 2019
- 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 |
|---|---|---|---|---|
| Pediatric Registered Nurse | 163WP0200X | 968529 | TX | Primary |
Addresses
Primary practice location
3603 Barberry Dr
Wylie, TX 75098-8557
Mailing address
3603 Barberry Dr
Wylie, TX 75098-8557
Phone (469) 386-4484
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
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 968529 | TX | MD | Pediatric Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560124800000",
"number": "1407415805",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3603 BARBERRY DR",
"city": "WYLIE",
"state": "TX",
"postal_code": "750988557",
"telephone_number": "469-386-4484"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3603 BARBERRY DR",
"city": "WYLIE",
"state": "TX",
"postal_code": "750988557",
"telephone_number": "469-386-4484"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNESON",
"first_name": "JESSICA",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-06-10",
"last_updated": "2019-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "163WP0200X",
"taxonomy_group": "",
"desc": "Registered Nurse, Pediatrics",
"state": "TX",
"license": "968529",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wylie, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.