Active NPI
Raymond Vernon Kennedy
- Professional Counselor
- Brandon, MS
National Provider Identifier
1609467414
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- P-0585
- Practice address
- 721 S College St
Brandon, MS 39042-3605 - Phone
- (601) 906-6742
- NPI assigned
- Feb 3, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | P-0585 | MS | Primary |
Addresses
Primary practice location
721 S College St
Brandon, MS 39042-3605
Mailing address
721 S College St
Brandon, MS 39042-3605
Phone (601) 906-6742
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P-0585 | Other | MS | STATE LICENSE NUMBER LPC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Previously, effective Aug 29, 2024 through Aug 29, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P-0585 | MS | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1612310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1612310400000",
"number": "1609467414",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "721 S COLLEGE ST",
"city": "BRANDON",
"state": "MS",
"postal_code": "390423605",
"telephone_number": "601-906-6742"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "721 S COLLEGE ST",
"city": "BRANDON",
"state": "MS",
"postal_code": "390423605",
"telephone_number": "601-906-6742"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "RAYMOND",
"middle_name": "VERNON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-02-03",
"last_updated": "2021-02-03",
"certification_date": "2021-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MS",
"license": "P-0585",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER LPC",
"identifier": "P-0585",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brandon, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.