Kenjack Medical LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

0102036923 Issued in VA

Legal business name

KENJACK MEDICAL LLC

Practice address

951 W 21St St
Norfolk, VA 23517-1534

Phone

(757) 274-4452

Fax

(757) 531-7723

NPI assigned

Dec 17, 2015

Last updated

May 1, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Garrett M Kelly, D.O.NPI 1407820939

Title

President

Phone

(757) 274-4452

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Garrett Kelly, MD

  • Family Medicine Physician
  • Virginia Beach, VA
  • NPI 1407820939
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1450310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493596800000",
    "number": "1528423555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "951 W 21ST ST",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235171534",
            "telephone_number": "757-274-4452",
            "fax_number": "757-531-7723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 W 21ST ST",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235171534",
            "telephone_number": "757-274-4452",
            "fax_number": "757-531-7723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENJACK MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-17",
        "last_updated": "2017-05-01",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "GARRETT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-274-4452",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0102036923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janet K Kempf
• Kempsville Behavioral Health Pharmacy
• Kemwood Care Services
• Julie A Kendall, PSYD
• Desmond Osei Kenewa
• Karen Elizabeth Kennamer, MD
• Kendra Kennedy, PA
• Leah Kennedy, MSW, LCSW
• Rachel Scott Kennedy, MD
• Sarah Elizabeth Kennedy, N.P

• Family Medicine Physician in Norfolk, VA
• Providers in Norfolk, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.