Shannon Kelly Kennedy, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1088162 Issued in TX

Practice address

3667 County Road 2134 Ste C
Caddo Mills, TX 75135-6897

Phone

(903) 751-5550

Fax

(833) 973-3638

NPI assigned

Jun 7, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/11247/brand/1/csg/1/fhir/r4
• Direct secure messaging: shannon.kennedy.1@11247.direct.athenahealth.com

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.

• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  Nurse Practitioner

  Medicare reassignment NPD
• Jordan's Place Pediatrics, PA

  • Rural Health Clinic/Center
  • Sulphur Springs, TX
  • NPI 1063277903
  NPD (past)
• Jordan's Place Pediatrics, PA

  • Primary Care Clinic/Center
  • Sulphur Springs, TX
  • NPI 1245419431
  NPD (past)

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

{
    "created_epoch": "1654560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789344000000",
    "number": "1457080228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3667 COUNTY ROAD 2134 STE C",
            "city": "CADDO MILLS",
            "state": "TX",
            "postal_code": "751356897",
            "telephone_number": "903-751-5550",
            "fax_number": "833-973-3638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3667 COUNTY ROAD 2134 STE C",
            "city": "CADDO MILLS",
            "state": "TX",
            "postal_code": "751356897",
            "telephone_number": "903-751-5550",
            "fax_number": "833-973-3638"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2504 Ridge Rd Ste 203",
            "address_purpose": "LOCATION",
            "city": "Rockwall",
            "state": "TX",
            "postal_code": "750872571",
            "country_code": "US",
            "telephone_number": "469-887-5550",
            "fax_number": "833-973-3638",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "SHANNON",
        "middle_name": "KELLY",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-07",
        "last_updated": "2026-09-14",
        "certification_date": "2026-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1088162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hearted Rejuvenation LLC
• Hunt Memorial Hospital District (Hunt Regional Family Medicine Caddo Mills)
• Hunt Regional Medical Partners (Hunt Regional Family Medicine Caddo Mills)
• Xanth Marie Jeffery, LMT
• Wendy Kemp
• Naomi Kay Kramer, FNP-C
• Amy Mathew
• Shawna Moreland
• Sharon L Paine, NP
• Courtney Patrick, NP

• Family Nurse Practitioner in Caddo Mills, TX
• Providers in Caddo Mills, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2026; 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.