Active NPI
Mark Kennedy, ATC
- Other Specialist/Technologist
- Wichita, KS
National Provider Identifier
1699189845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Specialist/Technologist
- License
- 24-00513
- Practice address
- 707 N Emporia St
Wichita, KS 67214-3707 - Phone
- (316) 858-3524
- NPI assigned
- Jun 16, 2014
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Other Specialist/Technologist | 246Z00000X | 24-00513 | KS | Primary |
Addresses
Primary practice location
707 N Emporia St
Wichita, KS 67214-3707
Mailing address
7703 W Shadow Lakes St
Wichita, KS 67205-1913
Phone (316) 425-0692
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 |
|---|---|---|---|
| 24-00513 | KS | MD | Other Specialist/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402876800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402876800000",
"number": "1699189845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7703 W SHADOW LAKES ST",
"city": "WICHITA",
"state": "KS",
"postal_code": "672051913",
"telephone_number": "316-425-0692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 N EMPORIA ST",
"city": "WICHITA",
"state": "KS",
"postal_code": "672143707",
"telephone_number": "316-858-3524"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "MARK",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-06-16",
"last_updated": "2014-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "246Z00000X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other",
"state": "KS",
"license": "24-00513",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.