Active NPI
Beth A. Kennedy, NP
- Family Nurse Practitioner
- Flagstaff, AZ
National Provider Identifier
1669544383
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- AP1689
- Practice address
- 930 N Switzer Canyon Dr
Suite 202
Flagstaff, AZ 86001-4824 - Phone
- (928) 779-5707
- Fax
- (928) 779-5753
- NPI assigned
- Nov 15, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | AP1689 | AZ | Primary |
Addresses
Primary practice location
930 N Switzer Canyon Dr
Suite 202
Flagstaff, AZ 86001-4824
Mailing address
930 N Switzer Canyon Dr
Suite 202
Flagstaff, AZ 86001-4824
Phone (928) 779-5707
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AP1689 | Other | AZ | NP LICENSE # |
| RN121857 | Other | AZ | RN LICENSE # |
| 202101 | Medicaid | AZ |
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1689 | AZ | MD | Occupational Therapy Assistant |
| AP1689 | AZ | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1391731200000",
"number": "1669544383",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "930 N SWITZER CANYON DR",
"address_2": "SUITE 202",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860014824",
"telephone_number": "928-779-5707",
"fax_number": "928-779-5753"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "930 N SWITZER CANYON DR",
"address_2": "SUITE 202",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860014824",
"telephone_number": "928-779-5707",
"fax_number": "928-779-5753"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "BETH",
"middle_name": "A.",
"name_prefix": "Ms.",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-15",
"last_updated": "2014-02-07",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "AZ",
"license": "AP1689",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NP LICENSE #",
"identifier": "AP1689",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RN LICENSE #",
"identifier": "RN121857",
"state": "AZ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "202101",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flagstaff, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.