Active NPI
Misty Nicole Kennedy
- Occupational Therapist
- Monroe, LA
National Provider Identifier
1730701178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 307751
- Practice address
- 442 E Frenchmans Bend Rd
Monroe, LA 71203-8852 - Phone
- (318) 503-9789
- NPI assigned
- May 7, 2020
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 307751 | LA | Primary |
Addresses
Primary practice location
442 E Frenchmans Bend Rd
Monroe, LA 71203-8852
Mailing address
2712 Crow Farm Rd
Marion, LA 71260-4129
Phone (318) 805-6702
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200608001284 | LA | Practitioner - Occupational Therapist in Private Practice | 4789005364 | Reassigns benefits to 2 organizations |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 307751 | LA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sterlington Physical Therapy, LLC | Current | Accepting new patients | |
| Dynamic Therapy Solutions, LLC | Current | Accepting new patients | |
| PT Partners, LLC | Past | Accepting new patients |
Locations
8649 Highway 165 N
Ste 5
Monroe, LA 71203
Phone (318) 235-9326
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.
-
- Physical Therapist
- Bastrop, LA
- NPI 1912617994
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588809600000",
"number": "1730701178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2712 CROW FARM RD",
"city": "MARION",
"state": "LA",
"postal_code": "712604129",
"telephone_number": "318-805-6702"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "442 E FRENCHMANS BEND RD",
"city": "MONROE",
"state": "LA",
"postal_code": "712038852",
"telephone_number": "318-503-9789"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "MISTY",
"middle_name": "NICOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-07",
"last_updated": "2020-05-07",
"certification_date": "2020-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "LA",
"license": "307751",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monroe, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.