John P Kenney, D.D.S., P.A

Primary specialty

DentistTaxonomy code 122300000X

License

3178-01 Issued in MS

Practice address

101 Park Gate Dr
Tupelo, MS 38801-3033

Phone

(662) 840-1535

Fax

(662) 844-3823

NPI assigned

May 10, 2007

Sex

Male

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

Enrolled in TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Tupelo Smiles Family and Cosmetic Dentistry

  • General Practice Dentistry
  • Tupelo, MS
  • NPI 1134246630
  NPD (past) Authorized official

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609080407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 PARK GATE DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388013033",
            "telephone_number": "662-840-1535",
            "fax_number": "662-844-3823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 PARK GATE DR",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388013033",
            "telephone_number": "662-840-1535",
            "fax_number": "662-844-3823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEY",
        "first_name": "JOHN",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "D.D.S., P.A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "3178-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blake Austin Kennedy, FNP-C
• Elizabeth Kennedy
• Elizabeth Ann Kennedy, RN
• Emilee Kennedy
• Kenneth a Grinspun, M.D. P.a.
• Brandi South Kent, PHARM D
• Morgan Kent, M.S., BCBA, LBA
• Runeisha Kersey
• Santita Keys
• Muhammad Shahzeb Khan Khakwani, MD

• Dentist in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Dentist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.