Marie Antoinette Kennedy

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

71007869A Issued in IN

Practice address

611 E Douglas Rd Ste 208
Mishawaka, IN 46545-1465

Phone

(574) 335-6000

Fax

(574) 335-0738

NPI assigned

Feb 1, 2018

Last updated

Jun 19, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Franciscan Physician NetworkGroup PAC ID 3072790682, 1,152 clinicians

Saint Joseph Regional Medical Center IncGroup PAC ID 8325950843, 137 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Joseph Regional Medical Center Hospital, Mishawaka, IN, CCN 150012

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Franciscan Physician Network

  • Family Medicine Physician
  • Indianapolis, IN
  • NPI 1225327984
  Medicare reassignment Care Compare group NPD
• Saint Joseph Regional Medical Center, Inc.

  dba Saint Joseph Medical Group

  • Pulmonary Disease Physician
  • Plymouth, IN
  • NPI 1225082878
  Medicare reassignment Care Compare group
• Franciscan Physician Network

  • Clinic/Center
  • Lafayette, IN
  • NPI 1992543250
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1023965795
  Care Compare affiliation
• Saint Joseph Regional Medical Center-South Bend Campus, Inc.

  • General Acute Care Hospital
  • Mishawaka, IN
  • NPI 1841245594
  Care Compare affiliation

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

{
    "created_epoch": "1517443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718755200000",
    "number": "1851899140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 CEDAR ST STE 200",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466172057",
            "telephone_number": "574-335-8707",
            "fax_number": "574-335-0741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 E DOUGLAS RD STE 208",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451465",
            "telephone_number": "574-335-6000",
            "fax_number": "574-335-0738"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1668 S US Highway 421",
            "address_purpose": "LOCATION",
            "city": "Westville",
            "state": "IN",
            "postal_code": "463919523",
            "country_code": "US",
            "telephone_number": "219-785-8424",
            "fax_number": "888-692-8982",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3500 Franciscan Way Ste 400",
            "address_purpose": "LOCATION",
            "city": "Michigan City",
            "state": "IN",
            "postal_code": "463600033",
            "country_code": "US",
            "telephone_number": "219-878-8200",
            "fax_number": "219-878-8331",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "MARIE",
        "middle_name": "ANTOINETTE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-02-01",
        "last_updated": "2024-06-19",
        "certification_date": "2024-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71007869A",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "71007869A",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "28143781A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas S Keller, LCSW
• Rebecca Kelver, RBT
• Mechelle E Kemp, RN
• Allyssa Marie Kempf
• Kenmark Home Care, LLC
• Melissa J Kennedy
• Amber M Kenney, NP
• Elizabeth Kerns
• Mary A Kertes, RPH
• Erin Marie Kevern, D.O.

• Nurse Practitioner in Mishawaka, IN
• Providers in Mishawaka, IN by specialty
• Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.