Marly Kennedy, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

200450131NP Issued in OR

Practice address

1975 McPherson St
Suite 2
North Bend, OR 97459-3482

Phone

(541) 756-2020

Fax

(541) 756-8982

NPI assigned

May 31, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Marly Baker Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Nurse Practitioner

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

{
    "created_epoch": "1180569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545955200000",
    "number": "1801097183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1975 MCPHERSON ST",
            "address_2": "SUITE 2",
            "city": "NORTH BEND",
            "state": "OR",
            "postal_code": "974593482",
            "telephone_number": "541-756-2020",
            "fax_number": "541-756-8982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 MCPHERSON ST",
            "address_2": "SUITE 2",
            "city": "NORTH BEND",
            "state": "OR",
            "postal_code": "974593482",
            "telephone_number": "541-756-2020",
            "fax_number": "541-756-8982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "MARLY",
        "name_prefix": "Ms.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-31",
        "last_updated": "2018-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "200450131NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARLY",
            "last_name": "BAKER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Peter Alan Karth, MD
• Teneisha C Kay, RN
• Richard Keith
• Elizabeth Kellner, DDS
• Matthew Ewing Kelm
• Rene P Kidinger
• Dustin W King
• Stephen Jay Kinsley, M.D.
• Jon Kintner, M.D.
• Hannah R Kirk

• Psychiatric/Mental Health Nurse Practitioner in North Bend, OR
• Providers in North Bend, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2018; 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.