Candice Kennerly

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-23-69822 Issued in FL

Practice address

520 Palm Coast Pkwy SW Ste 103
Palm Coast, FL 32137-4743

Phone

(386) 225-4940

NPI assigned

Jul 22, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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.

• Echo Community Outreach Inc

  • Developmentally Disabled Services Day Training Agency
  • Palm Coast, FL
  • NPI 1780221903
  NPD

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

{
    "created_epoch": "1563753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742428800000",
    "number": "1801449558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 BLAINE DR",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321377324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 PALM COAST PKWY SW STE 103",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321374743",
            "telephone_number": "386-225-4940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNERLY",
        "first_name": "CANDICE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-22",
        "last_updated": "2025-03-20",
        "certification_date": "2025-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Assistant Behavior Analyst",
            "state": "FL",
            "license": "0-19-9711",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "1-23-69822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Keen, M.D.
• Lydia Kefalidou, MD
• Ellen Kellogg, M.A.CCC-SLP
• Shaniqua Kelly
• Shannon Kelly
• Jennifer Lynn Kernon, OTA/L
• Kevin R Thorpe LLC
• Amr Khalifa, MD
• Muhammad Shayan Khan, MD
• Awarish Khawaja

• Behavior Analyst in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 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.

Verify at the official NPI Registry.