Criswell Allen Kennedy, M.D.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

MD00017804 Issued in WA

Practice address

24128 E Alki LN
Liberty Lake, WA 99019-9447

Phone

(509) 255-5065

Fax

(509) 477-6352

NPI assigned

Apr 16, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

• Empire Health Services

  dba Deaconess Medical Center

  • General Acute Care Hospital
  • Spokane, WA
  • NPI 1336194893
  NPD (past)
• Inland Empire Dermatology, PS

  • Procedural Dermatology Physician
  • Spokane Valley, WA
  • NPI 1811004757
  NPD (past)

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

{
    "created_epoch": "1176681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1912122847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24128 E ALKI LN",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990199447",
            "telephone_number": "509-255-5065",
            "fax_number": "509-477-6352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24128 E ALKI LN",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990199447",
            "telephone_number": "509-255-5065",
            "fax_number": "509-477-6352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "CRISWELL",
        "middle_name": "ALLEN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WA",
            "license": "MD00017804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dana Jwad, DMD
• Lauren E Kalberer, L.M.P.
• Karey Kananda, APRN
• Lisa June Kangas, OTR
• Keenan Milonas M.D. Professional Services PLLC (Custom MD)
• Kinetic Chiropractic LLC
• Kingsford Physical Therapy and Wellness PLLC
• Braiden Kingsford, DPT
• Leaann P Kinney, PHARMD
• Kenzi Kuemper

• General Practice Physician in Liberty Lake, WA
• Providers in Liberty Lake, WA by specialty
• General Practice Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.