Individual provider Active NPI

Michelle Lynn Kennedy, NP

  • Family Nurse Practitioner
  • Waterbury, CT
National Provider Identifier
1891836110
Registry record updated Nov 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3620 Issued in CT
Practice address
51 N Elm St
Waterbury, CT 06702-1511
Phone
(203) 574-4000
Fax
(203) 574-4003
NPI assigned
Feb 9, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 16084 CA
Family Nurse Practitioner 363LF0000X 3620 CT Primary

Addresses

Primary practice location

51 N Elm St
Waterbury, CT 06702-1511

Mailing address

635 Main St
Attn: Credentialing DPT
Middletown, CT 06457-2718
Phone (860) 347-6971

Other identifiers 1

IdentifierTypeStateIssuer
004236346MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
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

Enrollment IDStateProvider typePAC IDDetails
I20080505000161 CT Practitioner - Nurse Practitioner 8123114493 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cornell Scott Hill Health CorporationGroup PAC ID 3072418359, 261 clinicians

Practice addresses (Care Compare)

428 Columbus Ave
New Haven, CT 06519-1233
Phone (203) 503-3228

Hospital & facility affiliations

  • Yale-New Haven Hospital Hospital, New Haven, CT, CCN 070022

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
003620CTMDProfessional Counselor
3620CTMDDental Hygienist
16084CAMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Swan Integrative Health & Wellness LLC CurrentSince Sep 1, 2019 Accepting new patients
Yale University CurrentSince Sep 14, 2014 Accepting new patients
Yale University CurrentSince Sep 14, 2014 Accepting new patients
Cornell Scott Hill Health Corporation CurrentSince Feb 1, 2024 Accepting new patients
Cornell Scott Hill Health Corporation Past Accepting new patients

Locations

49 Welles St
Ste 215
Glastonbury, CT 06033
Phone (860) 325-2679

197 Dixwell Ave
New Haven, CT 06511
Phone (203) 500-2147

428 Columbus Ave
New Haven, CT 06519
Phone (203) 503-3228

55 Lock St
Fl 4
New Haven, CT 06511

55 Lock St
New Haven, CT 06511
Phone (203) 432-0076

Interoperability endpoints

  • Direct secure messaging: mkennedy174049@direct.ynhh.org
  • Direct secure messaging: michelle.kennedy@chcict.eclinicaldirectplus.com

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320105600000",
    "number": "1891836110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "635 MAIN ST",
            "address_2": "ATTN: CREDENTIALING DPT",
            "city": "MIDDLETOWN",
            "state": "CT",
            "postal_code": "064572718",
            "telephone_number": "860-347-6971",
            "fax_number": "860-638-6601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 N ELM ST",
            "city": "WATERBURY",
            "state": "CT",
            "postal_code": "067021511",
            "telephone_number": "203-574-4000",
            "fax_number": "203-574-4003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "MICHELLE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-09",
        "last_updated": "2011-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "16084",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CT",
            "license": "3620",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236346",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterbury, CT

Sources for this page

Verify at the official NPI Registry.