Kenneth A Widra, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

0101041002 Issued in VA

Practice address

1241 N Main St
Harrisonburg, VA 22802-4632

Phone

(540) 434-1941

Fax

(540) 433-8277

NPI assigned

Aug 3, 2005

Last updated

Jun 6, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kennethwidra@tdh.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Teladoc Health Medical Group, P.a.

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  • NPI 1245403567

  Psychiatry

  NPD
• Psychiatric Associates of the Shenandoah

  • Clinical Social Worker
  • Waynesboro, VA
  • NPI 1053360263
  NPD (past)

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

{
    "created_epoch": "1123027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496707200000",
    "number": "1801897608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6040 PUBLIC LANDING ROAD",
            "city": "SNOW HILL",
            "state": "MD",
            "postal_code": "21863",
            "telephone_number": "410-632-1100",
            "fax_number": "410-632-2476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1241 N MAIN ST",
            "city": "HARRISONBURG",
            "state": "VA",
            "postal_code": "228024632",
            "telephone_number": "540-434-1941",
            "fax_number": "540-433-8277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDRA",
        "first_name": "KENNETH",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-03",
        "last_updated": "2017-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VA",
            "license": "0101041002",
            "primary": true
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "VA",
            "license": "0101041002",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "A164832",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004945166",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SENTARA OPTIMA",
            "identifier": "084255",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "216331000",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "258840",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• C. Larry Whitten, M.D.
• Hillary Whonder-Genus, M.D.
• James Randall Wickham, M.D.
• Philip W Wickline
• Rebeca Susan Wickline, M.A.,SLP
• Matthew Wikswo, LPC
• Michael W Wilburn, MPT
• Wildflower Counseling and Wellness, LLC
• Sara Stover Wilfong, R.D.
• Katelyn Ciara Lambert Wilkins, NP

• Psychiatry Physician in Harrisonburg, VA
• Providers in Harrisonburg, VA by specialty
• Psychiatry Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2017; 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.