Kennedy Brea Faulkenberry

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

201971 Issued in AR

Practice address

1710 Moores LN
Texarkana, TX 75503-1858

Phone

(903) 794-2705

NPI assigned

Aug 3, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kennedy Brea Blue Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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.

• Temple Memorial Pediatric Center Inc.

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Texarkana, TX
  • NPI 1972654663
  NPD

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

{
    "created_epoch": "1659484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695772800000",
    "number": "1780311316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "154 YARBOROUGH AVE",
            "city": "ASHDOWN",
            "state": "AR",
            "postal_code": "718228446",
            "telephone_number": "870-200-5062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1710 MOORES LN",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755031858",
            "telephone_number": "903-794-2705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAULKENBERRY",
        "first_name": "KENNEDY",
        "middle_name": "BREA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-08-03",
        "last_updated": "2023-09-27",
        "certification_date": "2023-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "AR",
            "license": "201971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENNEDY",
            "last_name": "BLUE",
            "middle_name": "BREA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Family Practice of Texarkana PLLC
• Fannin County Hospital Authority
• Fannin County Hospital Authority
• Fannin County Hospital Authority
• Jason Faris, OTR
• Fci Texarkana
• Betty J Feir, PH.D
• Richard L Fender, CRNA
• Christopher Alan Ferguson, DDS
• Gissel Fernandez

• Speech-Language Pathologist in Texarkana, TX
• Providers in Texarkana, TX by specialty
• Speech-Language Pathologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.