Active NPI
Maegen Ricki Kennedy, PA-C
- Medical Physician Assistant
- Austin, TX
National Provider Identifier
1801165485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA07534
- Practice address
- 4107 South Captial Texas Hwy Suite 100a
Austin, TX 78704 - Phone
- (512) 443-9355
- NPI assigned
- Dec 28, 2011
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA07534 | TX | Primary |
Addresses
Primary practice location
4107 South Captial Texas Hwy Suite 100a
Austin, TX 78704
Mailing address
300 West Ave Apt 1327
Austin, TX 78701
Phone (239) 898-0054
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 |
|---|---|---|---|
| PA07534 | TX | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1325030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325030400000",
"number": "1801165485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 WEST AVE APT 1327",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78701",
"telephone_number": "239-898-0054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4107 SOUTH CAPTIAL TEXAS HWY SUITE 100A",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78704",
"telephone_number": "512-443-9355"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "MAEGEN",
"middle_name": "RICKI",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-12-28",
"last_updated": "2011-12-28",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "TX",
"license": "PA07534",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.