Alexandra Ricker Kennedy, DDS, MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

35680 Issued in TX

Practice address

3805 Brookside Dr
Tyler, TX 75701-9421

Phone

(903) 581-2900

Fax

(903) 509-0160

NPI assigned

Jul 9, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Mary Alexandra Ricker Professional name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Tyler Periodontics, PLLC

  • Periodontics
  • Tyler, TX
  • NPI 1619331634
  NPD (past)

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

{
    "created_epoch": "1562630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1891347951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3805 BROOKSIDE DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757019421",
            "telephone_number": "903-581-2900",
            "fax_number": "903-509-0160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3805 BROOKSIDE DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757019421",
            "telephone_number": "903-581-2900",
            "fax_number": "903-509-0160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "ALEXANDRA",
        "middle_name": "RICKER",
        "name_prefix": "Dr.",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-09",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "35680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "RICKER",
            "middle_name": "ALEXANDRA",
            "prefix": "DR.",
            "credential": "DDS MS",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Kendall DDS PLLC
• Kimberly Kendrick
• Rubye J Kendrick, PT
• Sara Kenna, RRT
• Ashlynn Kennard, COTA
• Bruna Lemos Kennedy, DDS
• Jasmine Kennedy
• Kyle Kennedy
• Tamera Kennedy
• Grace Opoku Kenney, DO

• Periodontics in Tyler, TX
• Providers in Tyler, TX by specialty
• Periodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.