Charles Reggie Kennedy Sr., CERTIFIED ORTHOTIST

Primary specialty

OrthotistTaxonomy code 222Z00000X

License

C0004097 Issued in MS

Practice address

777 Lakeland Dr
Jackson, MS 39216-4611

Phone

(601) 815-4844

NPI assigned

Mar 10, 2010

Sex

Male

Sole proprietor

Yes

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

Interoperability endpoints

• Direct secure messaging: ckennedy5612@ummc.direct-ci.com

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.

• University Physicians, PLLC

  • Internal Medicine Physician
  • Jackson, MS
  • NPI 1609984574
  NPD (past)

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

{
    "created_epoch": "1268179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268179200000",
    "number": "1548583172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "503 CEDAR ST",
            "city": "MIZE",
            "state": "MS",
            "postal_code": "391165572",
            "telephone_number": "601-733-2327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 LAKELAND DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164611",
            "telephone_number": "601-815-4844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "CHARLES",
        "middle_name": "REGGIE",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "CERTIFIED ORTHOTIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-03-10",
        "last_updated": "2010-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "MS",
            "license": "C0004097",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carly Kendrick
• Daryl Kendrick, ATC-L, CSCS
• Jennifer Lashelle Kennard, D.O.
• Kennedy Behavioral Health Center, LLC
• Carol Anne Kennedy, PHARMD
• Daniel Kennedy, M.D.
• Daniel Davis Kennedy, MD
• John L Kennedy Jr., M.D.
• Kevin D Kennedy, PT
• Kyle Kennedy, MD

• Orthotist in Jackson, MS
• Providers in Jackson, MS by specialty
• Orthotist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2010; 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.