Guadalupe M Kennedy, CFNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

R30564 Issued in NM

Practice address

1515 W Fir St
Portales, NM 88130-5703

Phone

(575) 356-6695

Fax

(575) 356-5948

NPI assigned

Nov 2, 2005

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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.

• La Casa de Buena Salud Inc.

  dba La Casa Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Portales, NM
  • NPI 1972603165
  Medicare reassignment

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310428800000",
    "number": "1598756264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 843",
            "city": "PORTALES",
            "state": "NM",
            "postal_code": "881300843",
            "telephone_number": "575-356-6695",
            "fax_number": "575-356-5948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 W FIR ST",
            "city": "PORTALES",
            "state": "NM",
            "postal_code": "881305703",
            "telephone_number": "575-356-6695",
            "fax_number": "575-356-5948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "GUADALUPE",
        "middle_name": "M",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2011-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NM",
            "license": "R30564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "25484052",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Roxie Joyner, MA, LPCC, NCC
• Lydia Kakuze
• Amna K Kazi
• Audrey Kearney
• Lacy Keith, M.A.
• Kadie Ray Kiehne
• Matthew King
• Kylee Kinnamon
• Janie L Kiser
• Sierra Louise Kitchen

• Nurse Practitioner in Portales, NM
• Providers in Portales, NM by specialty
• Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2011; 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.

Verify at the official NPI Registry.