Active NPI
Patrick B Kennedy, DMD
- Dentist
- Louisville, KY
National Provider Identifier
1437147535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7958
- Practice address
- 4133 Taylor Blvd
Louisville, KY 40215-2341 - Phone
- (502) 368-8400
- Fax
- (502) 368-8423
- NPI assigned
- Oct 12, 2005
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 7958 | KY | Primary |
Addresses
Primary practice location
4133 Taylor Blvd
Louisville, KY 40215-2341
Mailing address
4133 Taylor Blvd
Louisville, KY 40215-2341
Phone (502) 368-8400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60002128 | Medicaid | KY |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7958 | KY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229558400000",
"number": "1437147535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4133 TAYLOR BLVD",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402152341",
"telephone_number": "502-368-8400",
"fax_number": "502-368-8423"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4133 TAYLOR BLVD",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402152341",
"telephone_number": "502-368-8400",
"fax_number": "502-368-8423"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "PATRICK",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-12",
"last_updated": "2008-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "7958",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60002128",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Louisville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.