Kenneth J Headen MD PA

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

License

9400266 Issued in NC

Legal business name

KENNETH J HEADEN MD PA

Practice address

806 Summit Ave
210A
Greensboro, NC 27405-7861

Phone

(336) 279-1227

Fax

(336) 279-1226

NPI assigned

Sep 21, 2012

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth Jay Headen, MD

Title

MD/Ceo

Phone

(336) 279-1227

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sharon Toney, MSW, LCSW

  • Clinical Social Worker
  • Greensboro, NC
  • NPI 1700935129
  NPD (past)

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

{
    "created_epoch": "1348185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348185600000",
    "number": "1780935395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 SUMMIT AVE STE 210A",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274057861",
            "telephone_number": "336-279-1227",
            "fax_number": "336-279-1226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "806 SUMMIT AVE",
            "address_2": "210A",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274057861",
            "telephone_number": "336-279-1227",
            "fax_number": "336-279-1226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH J HEADEN MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-21",
        "last_updated": "2012-09-21",
        "status": "A",
        "authorized_official_last_name": "HEADEN",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "MD/CEO",
        "authorized_official_telephone_number": "336-279-1227",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NC",
            "license": "9400266",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Reba Siler Kennedy
• Rebecca Smith Kennedy, MD
• Renee Kennedy, LMBT
• Susan Dana Kennedy, REV
• Amanda Kennelly
• Amber Mabe Kent, L. AC.
• Gabriel Eduardo Keogan
• Katie Marie Kepley
• Mercedes Sky Kepley
• Ruth Kellam Kerley, LCSW

• Community/Behavioral Health Agency in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Community/Behavioral Health Agency in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2012; 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.