Kennedy Family Medicine LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

KENNEDY FAMILY MEDICINE LLC

Practice address

1153 W 15TH St
Auburn, IN 46706-2061

Phone

(260) 222-1181

Fax

(260) 270-2800

NPI assigned

Jan 19, 2024

Organization subpart

No

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

Authorized official

Name

Crystal N Kennedy, NPNPI 1902267057

Title

Owner Operator

Phone

(260) 222-1181

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Crystal Nicole Kennedy, NP

  • Primary Care Nurse Practitioner
  • Auburn, IN
  • NPI 1902267057
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1705622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705968000000",
    "number": "1487415170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1153 W 15TH ST",
            "city": "AUBURN",
            "state": "IN",
            "postal_code": "467062061",
            "telephone_number": "260-222-1181",
            "fax_number": "260-270-2800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1153 W 15TH ST",
            "city": "AUBURN",
            "state": "IN",
            "postal_code": "467062061",
            "telephone_number": "260-222-1181",
            "fax_number": "260-270-2800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY FAMILY MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-19",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-22",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER OPERATOR",
        "authorized_official_telephone_number": "260-222-1181",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Alan Johnson, O.D.
• Cassandra Lynn Jones, PT
• Kayla Jordan
• Jeffrey L.Eonard Justice, MD
• Salisha D Keller
• Crystal Nicole Kennedy, NP
• Shirley Kisor, RPH
• Amy Kleeman, PT
• Lindsey Koble
• Kalyan Kondeti

• Family Medicine Physician in Auburn, IN
• Providers in Auburn, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.