Pro of Kennett, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

R0582 Issued in MO

Legal business name

PRO OF KENNETT, INC.

Practice address

306 Recovery Rd
Kennett, MO 63857-3267

Phone

(573) 888-9190

Fax

(573) 888-9404

NPI assigned

May 24, 2007

Last updated

Nov 15, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Tena R. Vandeventer

Title

Office Manager

Phone

(573) 888-9190

Specialties & licenses 4

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Thomas Hooper, PT, MHS

  • Specialist
  • Kennett, MO
  • NPI 1144278201
  Medicare reassignment
• Kristina Louise Provorse

  • Behavior Technician
  • Kennett, MO
  • NPI 1255090155
  NPD
• Judy Britton, MCD, CCC-SLP

  • Speech-Language Pathologist
  • Kennett, MO
  • NPI 1710935176
  NPD (past)

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195084800000",
    "number": "1811108608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 RECOVERY RD",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638573267",
            "telephone_number": "573-888-9190",
            "fax_number": "573-888-9404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 RECOVERY RD",
            "city": "KENNETT",
            "state": "MO",
            "postal_code": "638573267",
            "telephone_number": "573-888-9190",
            "fax_number": "573-888-9404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO OF KENNETT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2007-11-15",
        "status": "A",
        "authorized_official_last_name": "VANDEVENTER",
        "authorized_official_first_name": "TENA",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "573-888-9190",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MO",
            "license": "R0582",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MO",
            "license": "02042",
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MO",
            "license": "01506",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MO",
            "license": "107027",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI #",
            "identifier": "1144278201",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI #",
            "identifier": "1205884335",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI #",
            "identifier": "1710935176",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI #",
            "identifier": "1639127186",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Donna Faye Prenger
• Tyler Jay Preston
• Primary Eye Care Associates
• Kristina Louise Provorse
• Emma Quillin, LPC
• Tim Rabey
• Michelle Rasberry
• Adrienne Raspberry

• Specialist in Kennett, MO
• Providers in Kennett, MO by specialty
• Specialist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.