The Kennedy Clinic PLLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

THE KENNEDY CLINIC PLLC

Practice address

4957 Swinyar Dr Ste 109
Ooltewah, TN 37363-2205

Phone

(423) 396-9893

Fax

(423) 396-9508

NPI assigned

May 4, 2007

Organization subpart

No

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

Authorized official

Name

Howard Michael Kennedy, PA-CNPI 1942280052

Title

Managing Member

Phone

(423) 432-3130

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TN

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.

• Howard Michael Kennedy Jr., PA-C

  • Physician Assistant
  • Ooltewah, TN
  • NPI 1942280052
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726099200000",
    "number": "1508078445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4957 SWINYAR DR",
            "address_2": "SUITE 109",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "37363",
            "telephone_number": "423-432-3130",
            "fax_number": "423-396-9508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4957 SWINYAR DR STE 109",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373632205",
            "telephone_number": "423-396-9893",
            "fax_number": "423-396-9508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE KENNEDY CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "HOWARD",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "423-432-3130",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KENNEDY NPI#",
            "identifier": "1942280052",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KENNEDY SS#",
            "identifier": "413276426",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KENNEDY BCBS",
            "identifier": "4136940",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Clinic/Center in Ooltewah, TN
• Providers in Ooltewah, TN by specialty
• Primary Care Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 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.