Active NPI
Keith W Jennings, PH.D.
- Clinical Psychologist
- Fort Bragg, NC
National Provider Identifier
1922479641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 5042
- Practice address
- 2817 Reilly Road
Womack Army Medical Center
Fort Bragg, NC 28307 - Phone
- (910) 243-9262
- NPI assigned
- Oct 8, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810005241 | VA | |
| Clinical Psychologist | 103TC0700X | 5042 | NC | Primary |
Addresses
Primary practice location
2817 Reilly Road
Womack Army Medical Center
Fort Bragg, NC 28307
Mailing address
Womack Army Medical Ctr
2817 Reilly Road
Fort Bragg, NC 28310-7301
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810005241 | VA | MD | Clinical Psychologist |
| 5042 | NC | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444262400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478390400000",
"number": "1922479641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "WOMACK ARMY MEDICAL CTR",
"address_2": "2817 REILLY ROAD",
"city": "FORT BRAGG",
"state": "NC",
"postal_code": "283107301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2817 REILLY ROAD",
"address_2": "WOMACK ARMY MEDICAL CENTER",
"city": "FORT BRAGG",
"state": "NC",
"postal_code": "28307",
"telephone_number": "910-243-9262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENNINGS",
"first_name": "KEITH",
"middle_name": "W",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-10-08",
"last_updated": "2016-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810005241",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "5042",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Bragg, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.