Kennedy Correa

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

434963699396 Issued in TN

Practice address

4510 13TH Ave S
Fargo, ND 58103-5562

Phone

(701) 277-2579

NPI assigned

Mar 21, 2024

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Better This Wat Psychological Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fargo, ND
  • NPI 1245090679
  NPD Authorized official

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

{
    "created_epoch": "1710979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710979200000",
    "number": "1548020977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4510 13TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581035562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 13TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581035562",
            "telephone_number": "701-277-2579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORREA",
        "first_name": "KENNEDY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-21",
        "last_updated": "2024-03-21",
        "certification_date": "2024-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "TN",
            "license": "434963699396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cornerstone Caregiving East LLC
• Cornerstone Dental Group LLC
• Cornerstone Residential Services
• Cornervine Counseling, PLLC
• Amanda J Coronato, OTR/L
• Mellisa Cortright
• Erica Cossette
• Jason Cossette
• Kelly N Costello
• Heidi Maria Cottingham, MSW, BSW

• Massage Therapist in Fargo, ND
• Providers in Fargo, ND by specialty
• Massage Therapist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2024; 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.