Shannon Rene' Kennedy, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

1014885 Issued in TX

Practice address

400 Rosalind Redfern Grover Pkwy
Midland, TX 79701-5846

Phone

(432) 221-1111

NPI assigned

Jan 7, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Covenant Medical Group

  • Family Medicine Physician
  • Lubbock, TX
  • NPI 1376598904

  Hospitalist

  Medicare reassignment NPD
• Covenant Medical Group

  • Rural Health Clinic/Center
  • Abernathy, TX
  • NPI 1538412895
  NPD

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

{
    "created_epoch": "1609977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619654400000",
    "number": "1700474541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 NASHVILLE AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794101105",
            "telephone_number": "806-725-5411",
            "fax_number": "806-723-7766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 ROSALIND REDFERN GROVER PKWY",
            "city": "MIDLAND",
            "state": "TX",
            "postal_code": "797015846",
            "telephone_number": "432-221-1111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2509 W Shandon Ave",
            "address_purpose": "LOCATION",
            "city": "Midland",
            "state": "TX",
            "postal_code": "797056340",
            "country_code": "US",
            "telephone_number": "432-413-2023",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "SHANNON",
        "middle_name": "RENE'",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-07",
        "last_updated": "2021-04-29",
        "certification_date": "2021-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "722924",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "1014885",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "1014885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chandra Lynn Keele, RN, MSN, FNP-C
• Nathan Keller
• Foster Kemp
• Chelsey Rae Kendall, LPC
• Kylee Rebecca Kennedy, PA-S
• Dmitra Kentera, PA-S
• Heather Marie Kern Golson, O.D.
• Ketamine Clinic of West Texas
• Kevin Crutchfield LLC
• Keys to Wellness Chiropractic PLLC

• Family Nurse Practitioner in Midland, TX
• Providers in Midland, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2021; 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.