Individual provider Active NPI

Ruth Kennedy, CRNP

  • Women's Health Nurse Practitioner
  • Mobile, AL
National Provider Identifier
1558309732
Registry record updated Jan 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
1-028725 Issued in AL
Practice address
5870 Alumni Circle
Mobile, AL 36688-0002
Phone
(251) 460-7151
Fax
(251) 414-8227
NPI assigned
Jun 2, 2006
Last updated
Jan 26, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 1-028725 AL Primary

Addresses

Primary practice location

5870 Alumni Circle
Mobile, AL 36688-0002

Mailing address

5870 Alumni Circle
Mobile, AL 36688-0002
Phone (251) 460-7151

Other identifiers 5

IdentifierTypeStateIssuer
891003170MedicaidAL
308796400MedicaidFL
08224335MedicaidMS
51545538OtherALBCBS - 1610 CENTER ST
891003160MedicaidAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
1-028725ALMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
USA Health Physician Billing Services LLC Current Accepting new patients
USA Health - Mci Business Services LLC Current Accepting new patients
University of South Alabama PastSince Jan 31, 2021 Accepting new patients

Locations

1660 Spring Hill Ave
Mobile, AL 36604
Phone (251) 445-9616

1660 Spring Hill Ave
Ste 3069
Mobile, AL 36604
Phone (251) 445-8405

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1558309732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5870 ALUMNI CIRCLE",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366880002",
            "telephone_number": "251-460-7151",
            "fax_number": "251-460-7151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5870 ALUMNI CIRCLE",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366880002",
            "telephone_number": "251-460-7151",
            "fax_number": "251-414-8227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "RUTH",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-02",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "AL",
            "license": "1-028725",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891003170",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "308796400",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08224335",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS - 1610 CENTER ST",
            "identifier": "51545538",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891003160",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mobile, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; 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.