Active NPI
Deeanna Emmalynn Kenny, PA-C
- Physician Assistant
- Freeland, MI
National Provider Identifier
1902124266
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601005739
- Practice address
- 5694 Midland Rd
Freeland, MI 48623-8845 - Phone
- (989) 695-4999
- Fax
- (989) 695-4949
- NPI assigned
- May 12, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601005739 | MI | Primary |
Addresses
Primary practice location
5694 Midland Rd
Freeland, MI 48623-8845
Mailing address
4000 Wellness Dr
Midland, MI 48670-2000
Phone (844) 832-1956
Other practice location 1
4069 Lake Dr SE
Suite 117
Grand Rapids, MI 49546-8816
Phone (616) 267-7700
Other practice location 2
715 E Main St Ste 108
Midland, MI 48640-5488
Phone (989) 488-1150
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100813000955 | MI | Practitioner - Physician Assistant | 9032243951 | Reassigns benefits to 6 organizations |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601005739 | MI | MD | Physician Assistant |
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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1273622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1787011200000",
"number": "1902124266",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4000 WELLNESS DR",
"city": "MIDLAND",
"state": "MI",
"postal_code": "486702000",
"telephone_number": "844-832-1956",
"fax_number": "989-633-5241"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5694 MIDLAND RD",
"city": "FREELAND",
"state": "MI",
"postal_code": "486238845",
"telephone_number": "989-695-4999",
"fax_number": "989-695-4949"
}
],
"practiceLocations": [
{
"address_1": "4069 Lake Dr SE",
"address_2": "Suite 117",
"address_purpose": "LOCATION",
"city": "Grand Rapids",
"state": "MI",
"postal_code": "495468816",
"country_code": "US",
"telephone_number": "616-267-7700",
"fax_number": "616-267-8705",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "715 E Main St Ste 108",
"address_purpose": "LOCATION",
"city": "Midland",
"state": "MI",
"postal_code": "486405488",
"country_code": "US",
"telephone_number": "989-488-1150",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KENNY",
"first_name": "DEEANNA",
"middle_name": "EMMALYNN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-05-12",
"last_updated": "2026-08-18",
"certification_date": "2026-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601005739",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Freeland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2026; 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.