Individual provider Active NPI

Brooke Allison Devore Kennedy, PA-C

  • Physician Assistant
  • Milford, DE
National Provider Identifier
1720749864
Registry record updated May 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
C5-0011876 Issued in DE
Practice address
1012 Mattlind Way
Milford, DE 19963-5300
Phone
(024) 240-6003
Fax
(302) 422-6214
NPI assigned
Dec 30, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X C5-0011876 DE Primary

Addresses

Primary practice location

1012 Mattlind Way
Milford, DE 19963-5300

Mailing address

640 S State St # Mc3055
Dover, DE 19901-3530
Phone (302) 480-1688

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20230413001430 DE Practitioner - Physician Assistant 4284000225 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
May accept Medicare assignment
Group practices
Bayhealth Medical Center, IncGroup PAC ID 1658364740, 399 clinicians
Atracare Walk-in LLCGroup PAC ID 4486029592, 20 clinicians

Practice addresses (Care Compare)

1012 Mattlind Way
Bayhealth Primary Care
Milford, DE 19963-5300
Phone (302) 424-0600

18068 Coastal Hwy
Lewes, DE 19958-4901
Phone (302) 567-1500

640 S State St
Dover, DE 19901-3530

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
4452SCMDPhysical Therapy Assistant
C5-0011876DEMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bayhealth Medical Center, Inc CurrentSince Jan 16, 2024 Accepting new patients
Bayhealth Medical Center, Inc Past Accepting new patients

Locations

665 S Bay Rd
Unit B
Dover, DE 19901
Phone (302) 608-5312

640 S State St
Dover, DE 19901
Phone (302) 744-4700

640 S State St
#3055
Dover, DE 19901
Phone (302) 480-1688

Organizations & group practices 3

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1640822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716336000000",
    "number": "1720749864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 S STATE ST # MC3055",
            "city": "DOVER",
            "state": "DE",
            "postal_code": "199013530",
            "telephone_number": "302-480-1688",
            "fax_number": "302-480-9807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1012 MATTLIND WAY",
            "city": "MILFORD",
            "state": "DE",
            "postal_code": "199635300",
            "telephone_number": "024-240-6003",
            "fax_number": "302-422-6214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "BROOKE",
        "middle_name": "ALLISON DEVORE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-12-30",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "DE",
            "license": "C5-0011876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milford, DE

Sources for this page

Verify at the official NPI Registry.