Paul R. Kennedy, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

0506033 Issued in NV

Practice address

1670 NV-88
Minden, NV 89423

Phone

(702) 767-7424

NPI assigned

Aug 15, 2006

Last updated

May 30, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1639182876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "451 ROSEBEN CT",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895218360",
            "telephone_number": "702-767-7424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1670 NV-88",
            "city": "MINDEN",
            "state": "NV",
            "postal_code": "89423",
            "telephone_number": "702-767-7424"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "935 Mica Dr Ste 15",
            "address_purpose": "LOCATION",
            "city": "Carson City",
            "state": "NV",
            "postal_code": "897057181",
            "country_code": "US",
            "telephone_number": "775-783-3076",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "PAUL",
        "middle_name": "R.",
        "name_prefix": "Mr.",
        "credential": "LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NV",
            "license": "0506033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Minden, NV
• Providers in Minden, NV by specialty
• Athletic Trainer in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2024; 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.