Active NPI
Rovena R Kennedy, LDO
- Optician
- Prescott, AZ
National Provider Identifier
1750175535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- LDO-002414
- Practice address
- 3050 E State Route 69
Prescott, AZ 86301-6740 - Phone
- (928) 445-3933
- Fax
- (928) 443-8056
- NPI assigned
- Apr 7, 2025
- 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 |
|---|---|---|---|---|
| Optician | 156FX1800X | LDO-002414 | AZ | Primary |
Addresses
Primary practice location
3050 E State Route 69
Prescott, AZ 86301-6740
Mailing address
1365 Warbler Way
Prescott, AZ 86305-5849
Phone (928) 503-9975
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 |
|---|---|---|---|
| LDO-002414 | AZ | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1743984000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1743984000000",
"number": "1750175535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1365 WARBLER WAY",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863055849",
"telephone_number": "928-503-9975"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3050 E STATE ROUTE 69",
"city": "PRESCOTT",
"state": "AZ",
"postal_code": "863016740",
"telephone_number": "928-445-3933",
"fax_number": "928-443-8056"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "ROVENA",
"middle_name": "R",
"credential": "LDO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-04-07",
"last_updated": "2025-04-07",
"certification_date": "2025-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "AZ",
"license": "LDO-002414",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prescott, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.