Active NPI
Cynthia A Kennedy, NP
- Nurse Practitioner
- Wilbraham, MA
National Provider Identifier
1558461525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 164132
- Practice address
- 34 Sandalwood Dr
Wilbraham, MA 01095 - Phone
- (413) 244-2677
- NPI assigned
- Sep 22, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 164132 | MA | Primary |
Addresses
Primary practice location
34 Sandalwood Dr
Wilbraham, MA 01095
Mailing address
34 Sandalwood Dr
Wilbraham, MA 01095-1544
Phone (413) 244-2677
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220610001405 | MA | Order and Referring Only - Nurse Practitioner | 5092729947 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 164132 | MA | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533513600000",
"number": "1558461525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34 SANDALWOOD DR",
"city": "WILBRAHAM",
"state": "MA",
"postal_code": "010951544",
"telephone_number": "413-244-2677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34 SANDALWOOD DR",
"city": "WILBRAHAM",
"state": "MA",
"postal_code": "01095",
"telephone_number": "413-244-2677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "CYNTHIA",
"middle_name": "A",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-22",
"last_updated": "2018-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MA",
"license": "164132",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilbraham, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.