Individual provider Active NPI

Jennifer L. Kennedy, PT

  • Physical Therapist
  • Hattiesburg, MS
National Provider Identifier
1699094805
Registry record updated May 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT4008 Issued in MS
Practice address
710 William Carey Pkwy
Hattiesburg, MS 39401-7842
Phone
(601) 318-6335
NPI assigned
May 27, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT4008 MS Primary

Addresses

Primary practice location

710 William Carey Pkwy
Hattiesburg, MS 39401-7842

Mailing address

710 William Carey Pkwy
Hattiesburg, MS 39401-7842
Phone (601) 318-6335

Other practice location 1

7148 U S Highway 98 Ste 202
Hattiesburg, MS 39402-9133
Phone (601) 261-1550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120827000734 MS Practitioner - Physical Therapist in Private Practice 0446407456 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hattiesburg Clinic PAGroup PAC ID 5193706794, 525 clinicians

Practice addresses (Care Compare)

415 S 28TH Ave
Hattiesburg, MS 39401-7246
Phone (601) 264-6000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT4008MSMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Hattiesburg Clinic PA CurrentSince May 19, 2025 Accepting new patients
Hattiesburg Clinic, PA CurrentSince May 19, 2025 Accepting new patients
Medicomp, Inc Physical Therapist PastSince Mar 15, 2011 Accepting new patients
State of Mississippi - University of Mississippi Medical Center Past Accepting new patients
Medicomp, Inc Physical Therapist Past Accepting new patients
Hattiesburg Clinic, PA Past Accepting new patients

Locations

415 S 28th Ave
Hattiesburg, MS 39401
Phone (601) 261-3606

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1274918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747958400000",
    "number": "1699094805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 WILLIAM CAREY PKWY",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017842",
            "telephone_number": "601-318-6335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 WILLIAM CAREY PKWY",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394017842",
            "telephone_number": "601-318-6335"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7148 U S Highway 98 Ste 202",
            "address_purpose": "LOCATION",
            "city": "Hattiesburg",
            "state": "MS",
            "postal_code": "394029133",
            "country_code": "US",
            "telephone_number": "601-261-1550",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "JENNIFER",
        "middle_name": "L.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-05-27",
        "last_updated": "2025-05-23",
        "certification_date": "2025-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MS",
            "license": "PT4008",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.