Individual provider Active NPI

Kallean J Kennedy, DO

  • Emergency Medicine Physician
  • West Columbia, SC
National Provider Identifier
1659058477
Registry record updated Sep 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
97289 Issued in SC
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, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 22, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

TypeEndpointUseAffiliation
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
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
T-4947MSMDEmergency 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

Verify at the official NPI Registry.