Mary Laree Kenworthy

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

PN8104 Issued in ID

Practice address

500 W Fort St BLDG 88
Boise, ID 83702-4598

Phone

(208) 422-1000

Fax

(208) 422-1591

NPI assigned

Aug 31, 2020

Last updated

Aug 31, 2020By 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 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": "1598832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598832000000",
    "number": "1487267266",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 W FORT ST BLDG 88",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024598",
            "telephone_number": "208-422-1000",
            "fax_number": "208-422-1591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 W FORT ST BLDG 88",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837024598",
            "telephone_number": "208-422-1000",
            "fax_number": "208-422-1591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENWORTHY",
        "first_name": "MARY",
        "middle_name": "LAREE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-31",
        "last_updated": "2020-08-31",
        "certification_date": "2020-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "ID",
            "license": "8104",
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "ID",
            "license": "PN8104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Emery Kennedy, MD
• Michelle L Kennedy, NP
• Kenneth M Little
• Gregory J Kent, MD
• Victoria Maria Kent, MSW
• Stephanie Mae Kenyon
• Riley Kerin
• Kyle Kerkemeyer, CRNA
• Lisa Kern, MD
• Benjamin T Kerns, PA

• Licensed Practical Nurse in Boise, ID
• Providers in Boise, ID by specialty
• Licensed Practical Nurse in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; 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.