Active NPI
Iris T Kennedy, APRN
- Nurse Practitioner
- Little Rock, AR
National Provider Identifier
1609954148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- A002912
- Practice address
- 1300 Centerview Dr
Little Rock, AR 72211-4349 - Phone
- (501) 219-8900
- Fax
- (855) 407-3924
- NPI assigned
- Nov 1, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | A002912 | AR | Primary |
| Family Nurse Practitioner | 363LF0000X | A02912 | AR |
Addresses
Primary practice location
1300 Centerview Dr
Little Rock, AR 72211-4349
Mailing address
1300 Centerview Dr
Little Rock, AR 72211-4349
Phone (501) 219-8900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 163108758 | Medicaid | AR |
Other names 1
- Iris T Palencia
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1300 Centerview Dr
Little Rock, AR 72211-4349
Phone (501) 219-8900
1375 Superior Dr
Conway, AR 72032-7018
Phone (501) 219-8900
2504 W Main St
Suite a
Russellville, AR 72801-2536
Phone (501) 219-8900
4200 Stockton Dr
North Little Rock, AR 72117-2915
Phone (501) 410-1188
Hospital & facility affiliations
- St Marys Regional Medical Center
- Baptist Health Medical Center- Conway
- Conway Regional Medical Center, Inc
- Johnson Regional Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A002912 | AR | MD | Nurse Practitioner |
| A02912 | AR | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hot Springs MRI Center | Past | Accepting new patients |
Interoperability endpoints
- iris.kennedy.1@10448.direct.athenahealth.com
Organizations & group practices 2
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.
-
- Urology Physician
- Little Rock, AR
- NPI 1093720443
-
- Magnetic Resonance Imaging Radiologic Technologist
- Hot Springs, AR
- NPI 1801896410
Hospital & facility affiliations 9
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Conway, AR
- NPI 1285005140
-
- General Acute Care Hospital
- Conway, AR
- NPI 1497770424
-
- Family Medicine Physician
- Russellville, AR
- NPI 1245729359
Hospital
-
- Rural Health Clinic/Center
- Mayflower, AR
- NPI 1851389605
Hospital
-
- General Acute Care Hospital
- Clarksville, AR
- NPI 1134116049
-
- General Acute Care Hospital
- Russellville, AR
- NPI 1033160049
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724284800000",
"number": "1609954148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 CENTERVIEW DR",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722114349",
"telephone_number": "501-219-8900",
"fax_number": "855-407-3924"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 CENTERVIEW DR",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722114349",
"telephone_number": "501-219-8900",
"fax_number": "855-407-3924"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "IRIS",
"middle_name": "T",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-01",
"last_updated": "2024-08-22",
"certification_date": "2024-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "AR",
"license": "A002912",
"primary": true
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AR",
"license": "A02912",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "163108758",
"state": "AR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "IRIS",
"last_name": "PALENCIA",
"middle_name": "T",
"credential": "APRN",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.