NPIMap

Organization Active NPI

Kennett Pediatrics and Asolescents Medicine LLC

  • Family Medicine Physician
  • Kennett, MO
National Provider Identifier
1629511415
Registry record updated Nov 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KENNETT PEDIATRICS AND ASOLESCENTS MEDICINE LLC
Practice address
211 Teaco Rd
Kennett, MO 63857-3236
Phone
(573) 888-0001
Fax
(573) 888-0006
NPI assigned
Nov 28, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2016

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

Authorized official

Name
Amelia D Ledbetter
Title
Director of Operations
Phone
(573) 335-4715

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

211 Teaco Rd
Kennett, MO 63857-3236

Mailing address

211 Teaco Rd
Kennett, MO 63857-3236
Phone (573) 888-0001

National Provider Directory

National Provider Directory
Tax ID family
Kennett Pediatrics and Asolescents Medicine LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1480291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1480291200000",
    "number": "1629511415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 TEACO RD",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638573236",
            "telephone_number": "573-888-0001",
            "fax_number": "573-888-0006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 TEACO RD",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638573236",
            "telephone_number": "573-888-0001",
            "fax_number": "573-888-0006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETT PEDIATRICS AND ASOLESCENTS MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-28",
        "last_updated": "2016-11-28",
        "status": "A",
        "authorized_official_last_name": "LEDBETTER",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "573-335-4715"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kennett, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2016; 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.