NPIMap

Individual provider Active NPI

Jessica Kennemer, ARNP

  • Family Nurse Practitioner
  • Sayre, OK
National Provider Identifier
1861625691
Registry record updated Oct 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
58430 Issued in OK
Practice address
1002 NE Highway 66
Ste 2
Sayre, OK 73662-9305
Phone
(580) 928-2208
Fax
(580) 928-2246
NPI assigned
Aug 27, 2009
Last updated
Oct 25, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 58430 OK Primary

Addresses

Primary practice location

1002 NE Highway 66
Ste 2
Sayre, OK 73662-9305

Mailing address

1002 NE Highway 66
Ste 2
Sayre, OK 73662-9305
Phone (580) 928-2208

Other identifiers 1

IdentifierTypeStateIssuer
200261780AMedicaidOK

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jessica.kennemer.2@4696.direct.athenahealth.com Direct
Direct Messaging Address jessica.kennemer.1@4696.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091209000042 OK Practitioner - Nurse Practitioner 4082753793 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1007 N Main St
101 Comprehensive Spine and Pain
Elk City, OK 73644-2830
Phone (580) 339-8001

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Graham Family Medicine LLC CurrentSince Oct 2, 2012 Accepting new patients
Western Oklahoma Pain Specialists LLC CurrentSince May 28, 2024 Accepting new patients
Western Oklahoma Pain Specialists LLC CurrentSince May 28, 2024 Accepting new patients
Integris Ambulatory Care Corporation CurrentSince Nov 6, 2023 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Summit Medical Center Past Accepting new patients

Locations

1007 N Main St
Ste 101
Elk City, OK 73644

1901 W 3rd St
Ste C
Elk City, OK 73644
Phone (580) 225-9222

3400 NW Expressway
Ste 500
Oklahoma City, OK 73112
Phone (405) 945-4589

1002 NE Highway 66
Ste 2
Sayre, OK 73662
Phone (580) 928-2208

1723 Kansas Ave
Woodward, OK 73801
Phone (580) 256-4050

900 17th St
Woodward, OK 73801
Phone (405) 610-4411

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/16921/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir4.healow.com/fhir/r4/CCBBBD

Organizations & group practices 6

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1251331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635120000000",
    "number": "1861625691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1002 NE HIGHWAY 66",
            "address_2": "STE 2",
            "city": "SAYRE",
            "state": "OK",
            "postal_code": "736629305",
            "telephone_number": "580-928-2208",
            "fax_number": "580-928-2246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1002 NE HIGHWAY 66",
            "address_2": "STE 2",
            "city": "SAYRE",
            "state": "OK",
            "postal_code": "736629305",
            "telephone_number": "580-928-2208",
            "fax_number": "580-928-2246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEMER",
        "first_name": "JESSICA",
        "name_prefix": "Mrs.",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-27",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "58430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200261780A",
            "state": "OK"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jessica.kennemer.2@4696.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "amr direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1002 NE Highway 66",
            "address_2": "STE 2",
            "city": "Sayre",
            "state": "OK",
            "country_code": "US",
            "postal_code": "736629305",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jessica.kennemer.1@4696.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "AMR direct address",
            "address_1": "209 S 30th St",
            "city": "Clinton",
            "state": "OK",
            "country_code": "US",
            "postal_code": "736013657",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Sayre, OK

Sources for this page

Verify at the official NPI Registry.