Individual provider Active NPI

Theresa K Kennon, FNP-BC

  • Family Nurse Practitioner
  • Anchorage, AK
National Provider Identifier
1962523530
Registry record updated Feb 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
162389 Issued in AK
Practice address
4330 Elmore Rd
Anchorage, AK 99508-5907
Phone
(907) 729-6690
NPI assigned
Apr 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 162389 AK Primary

Addresses

Primary practice location

4330 Elmore Rd
Anchorage, AK 99508-5907

Mailing address

7033 E Tudor Rd
Anchorage, AK 99507-1262

Other practice location 1

550 W 7th Ave Fl 18
Anchorage, AK 99501-3571
Phone (907) 111-1111

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210712000926 TX Practitioner - Nurse Practitioner 1759324171 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southcentral FoundationGroup PAC ID 5496663627, 168 clinicians

Practice addresses (Care Compare)

4330 Elmore Rd
Anchorage, AK 99508-5907

Merit-based Incentive Payment System (MIPS)

Final score
91.77 of 100Reported as group
Quality
76.11
Promoting interoperability
100
Improvement activities
40
Cost
79.79

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
162389AKMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation CurrentSince Jul 1, 2021 Accepting new patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation Current Accepting new patients
Alaska Native Tribal Health Consortium CurrentSince Jul 1, 2021 Accepting new patients
Southcentral Foundation Current Accepting new patients
Southcentral Foundation Past Accepting new patients
Southcentral Foundation Past Accepting new patients
Southside Kidney Specialists Past Accepting new patients

Locations

7033 E Tudor Rd
Anchorage, AK 99507
Phone (907) 729-0000

4315 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-1729

4320 Diplomacy Dr
Anchorage, AK 99508
Phone (907) 729-0000

Organizations & group practices 11

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": "1175472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770681600000",
    "number": "1962523530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7033 E TUDOR RD",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995071262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4330 ELMORE RD",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085907",
            "telephone_number": "907-729-6690"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "550 W 7th Ave Fl 18",
            "address_purpose": "LOCATION",
            "city": "Anchorage",
            "state": "AK",
            "postal_code": "995013571",
            "country_code": "US",
            "telephone_number": "907-111-1111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KENNON",
        "first_name": "THERESA",
        "middle_name": "K",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-02",
        "last_updated": "2026-02-10",
        "certification_date": "2026-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AK",
            "license": "162389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anchorage, AK

Sources for this page

Verify at the official NPI Registry.