Heather C Kennedy, P.A.-C.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2191 Issued in OK

Practice address

7900 NW 23Rd St
Suite 1
Bethany, OK 73008-4961

Phone

(405) 470-3232

Fax

(405) 470-3233

NPI assigned

Dec 12, 2012

Last updated

Apr 26, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Heather C Lyles Former name

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Refine Medical

  • Family Medicine Physician
  • Oklahoma City, OK
  • NPI 1447977491
  NPD Authorized official
• Southwest Orthopaedic Specialists, P.L.L.C.

  • Orthopaedic Surgery Physician
  • Oklahoma City, OK
  • NPI 1669559720
  NPD (past)
• Summit Medical Center

  • General Acute Care Hospital
  • Edmond, OK
  • NPI 1356574560
  NPD (past)

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

{
    "created_epoch": "1355270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461628800000",
    "number": "1447596804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7900 NW 23RD ST",
            "address_2": "SUITE 1",
            "city": "BETHANY",
            "state": "OK",
            "postal_code": "730084961",
            "telephone_number": "405-470-3232",
            "fax_number": "405-470-3233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7900 NW 23RD ST",
            "address_2": "SUITE 1",
            "city": "BETHANY",
            "state": "OK",
            "postal_code": "730084961",
            "telephone_number": "405-470-3232",
            "fax_number": "405-470-3233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "HEATHER",
        "middle_name": "C",
        "credential": "P.A.-C.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-12",
        "last_updated": "2016-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OK",
            "license": "2191",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "2191",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "OK",
            "license": "2191",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200506010A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "LYLES",
            "middle_name": "C",
            "credential": "P.A.-C.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shannon L Kaneaster, MD
• Cynthia Diane Kappus, APRN, NP, CNS
• Cindy B Kearney
• Robert Gail Keeton, BSN, RN
• Ephraim Kelley
• Mia Kennedy
• Holly S Kessler, MD
• Mehreen Khan, DDS
• Ashley Kirkland, PT, DPT
• Tia Kirsch

• Physician Assistant in Bethany, OK
• Providers in Bethany, OK by specialty
• Physician Assistant in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.