Active NPI
Tanner Michael Kennedy
- Home Health Aide
- Granite Falls, WA
National Provider Identifier
1659832822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- License
- HM60927797
- Practice address
- 17807 Crooked Mile Rd Apt 7
Granite Falls, WA 98252-8742 - Phone
- (425) 598-3600
- NPI assigned
- Mar 28, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | HM60927797 | WA | Primary |
Addresses
Primary practice location
17807 Crooked Mile Rd Apt 7
Granite Falls, WA 98252-8742
Mailing address
1242 State Ave. Ste. I PMB 93
Marysville, WA 98270
Phone (425) 598-3600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HM60927797 | WA | MD | Home Health Aide |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1553731200000",
"number": "1659832822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1242 STATE AVE. STE. I PMB 93",
"city": "MARYSVILLE",
"state": "WA",
"postal_code": "98270",
"telephone_number": "425-598-3600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17807 CROOKED MILE RD APT 7",
"city": "GRANITE FALLS",
"state": "WA",
"postal_code": "982528742",
"telephone_number": "425-598-3600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "TANNER",
"middle_name": "MICHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-03-28",
"last_updated": "2019-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "WA",
"license": "HM60927797",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granite Falls, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.