Kathleen Kennedy, RN, IBCLC

Primary specialty

Lactation Consultant (Registered Nurse)Taxonomy code 163WL0100X

License

200440164RN Issued in OR

Practice address

7150 SW Dartmouth St
Tigard, OR 97223-7614

Phone

(503) 968-3480

NPI assigned

Apr 3, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

Practice roles

Locations

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.

• Pediatric Associates of the Northwest, PC

  • Pediatrics Physician
  • Tigard, OR
  • NPI 1174488787
  NPD
• Pediatric Associates of the Northwest, PC

  • Pediatrics Physician
  • Beaverton, OR
  • NPI 1528066859
  NPD (past)
• Pediatric Associates of the Northwest, PC

  • Pediatrics Physician
  • Portland, OR
  • NPI 1831054436
  NPD (past)

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

{
    "created_epoch": "1585872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1585872000000",
    "number": "1609405489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8112 SW 56TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972193223",
            "telephone_number": "503-780-3172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7150 SW DARTMOUTH ST",
            "city": "TIGARD",
            "state": "OR",
            "postal_code": "972237614",
            "telephone_number": "503-968-3480"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2701 NW Vaughn St Ste 360",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972105376",
            "country_code": "US",
            "telephone_number": "503-227-0671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "KATHLEEN",
        "name_prefix": "Mrs.",
        "credential": "RN, IBCLC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-03",
        "last_updated": "2020-04-03",
        "certification_date": "2020-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WL0100X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Lactation Consultant",
            "state": "OR",
            "license": "200440164RN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Centricity",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "7150 SW Dartmouth St",
            "city": "Tigard",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972237614",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Crystal Kelly
• Desiree Denise Kelly, RDH
• Justin Kemble, QMHP
• Mallory Alyse Kempton-Hein, PHARMD
• Ken R Erickson, M.D.
• Shannon M Kennedy
• Tyler C Kennedy
• Nicole H. Kennelly
• Johnny Keridwen
• Maura Kern Payne

• Lactation Consultant (Registered Nurse) in Tigard, OR
• Providers in Tigard, OR by specialty
• Lactation Consultant (Registered Nurse) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2020; 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.