Active NPI
Nancy Kennedy
- Nurse Practitioner
- Port Jefferson, NY
National Provider Identifier
1982785960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- F302544
- Practice address
- 75 N Country Rd
Port Jefferson, NY 11777-2119 - Phone
- (631) 473-1320
- Fax
- (631) 476-4279
- NPI assigned
- Oct 18, 2006
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | F302544 | NY | Primary |
Addresses
Primary practice location
75 N Country Rd
Port Jefferson, NY 11777-2119
Mailing address
625 Belle Terre Rd
Suite 100
Port Jefferson, NY 11777-2316
Phone (631) 473-1320
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)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 302544 | NY | MD | Licensed Practical Nurse |
| F302544 | NY | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445472000000",
"number": "1982785960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "625 BELLE TERRE RD",
"address_2": "SUITE 100",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117772316",
"telephone_number": "631-473-1320",
"fax_number": "631-476-4279"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75 N COUNTRY RD",
"city": "PORT JEFFERSON",
"state": "NY",
"postal_code": "117772119",
"telephone_number": "631-473-1320",
"fax_number": "631-476-4279"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY",
"first_name": "NANCY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-18",
"last_updated": "2015-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NY",
"license": "F302544",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Jefferson, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.