Olga Vladimirovna Kennedy, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

01061208A Issued in IN

Practice address

4420 76TH St NE
Marysville, WA 98270-3726

Phone

(360) 651-7490

NPI assigned

Mar 3, 2006

Last updated

Aug 21, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IN

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.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534809600000",
    "number": "1699742122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR",
            "city": "JBSA FT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4420 76TH ST NE",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982703726",
            "telephone_number": "360-651-7490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "OLGA",
        "middle_name": "VLADIMIROVNA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-03",
        "last_updated": "2018-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IN",
            "license": "01061208A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2021752",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William J. Kelleher, PH.D.
• Karen Kellett
• Kelly Howard Consulting
• Amanda Kelly, OTR
• Kelsey Scampoli
• Carol Kerr-Ragan, R.N.
• Debbie Ketchum, LMP
• Efrem T Kidane
• Amy Y Kim, PA-C
• Jaeyoung Kim, L.AC.

• Internal Medicine Physician in Marysville, WA
• Providers in Marysville, WA by specialty
• Internal Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.