Active NPI
Kallean J Kennedy, DO
- Emergency Medicine Physician
- West Columbia, SC
National Provider Identifier
1659058477
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 97289
- Practice address
- 2720 Sunset Blvd
West Columbia, SC 29169-4810 - Phone
- (803) 791-2350
- Fax
- (803) 791-2520
- NPI assigned
- Jul 3, 2023
- Last updated
- Sep 22, 2026
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | T-4947 | MS | |
| Emergency Medicine Physician | 207P00000X | 97289 | SC | Primary |
Addresses
Primary practice location
2720 Sunset Blvd
West Columbia, SC 29169-4810
Mailing address
PO Box 739949
Dallas, TX 75373-9949
Phone (803) 791-2350
Other practice location 1
611 Alcorn Dr
Corinth, MS 38834-9321
Phone (662) 293-7218
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kkendy206381@direct.lexmed.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T-4947 | MS | MD | Emergency Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1688342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790035200000",
"number": "1659058477",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 739949",
"city": "DALLAS",
"state": "TX",
"postal_code": "753739949",
"telephone_number": "803-791-2350",
"fax_number": "803-791-2520"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2720 SUNSET BLVD",
"city": "WEST COLUMBIA",
"state": "SC",
"postal_code": "291694810",
"telephone_number": "803-791-2350",
"fax_number": "803-791-2520"
}
],
"practiceLocations": [
{
"address_1": "611 Alcorn Dr",
"address_purpose": "LOCATION",
"city": "Corinth",
"state": "MS",
"postal_code": "388349321",
"country_code": "US",
"telephone_number": "662-293-7218",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KENNEDY",
"first_name": "KALLEAN",
"middle_name": "J",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-07-03",
"last_updated": "2026-09-22",
"certification_date": "2026-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "MS",
"license": "T-4947",
"primary": false
},
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "SC",
"license": "97289",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kkendy206381@direct.lexmed.com",
"affiliation": "N",
"address_1": "2720 Sunset Blvd",
"city": "West Columbia",
"state": "SC",
"country_code": "US",
"postal_code": "291694810",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in West Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2026; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.