Kenna Hogue Nettles, PA-C, ATC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA788 Issued in AL

Practice address

3719 Dauphin St
Mobile, AL 36608-1753

Phone

(251) 460-5333

Fax

(251) 460-5295

NPI assigned

Jan 16, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kenna Laine Hogue Former name

Medicare fee-for-service enrollment

Enrolled in MS

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

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

State of Mississippi - University of Mississippi Medical CenterGroup PAC ID 1850293036, 956 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• University of Mississippi Med Center Hospital, Jackson, MS, CCN 250001

Merit-based Incentive Payment System (MIPS)

Final score

83.94 of 100Reported as group

Quality

67.75

Promoting interoperability

100

Improvement activities

40

Cost

71.17

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: knettles178567@ummc.direct-ci.com

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.

• State of Mississippi - University of Mississippi Medical Center

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1154317527
  Medicare reassignment Care Compare group
• State of Mississippi - University of Mississippi Medical Center

  • Prosthetic/Orthotic Supplier
  • Jackson, MS
  • NPI 1235019530
  NPD
• State of Mississippi - University of Mississippi Medical Center

  • Rehabilitation Clinic/Center
  • Jackson, MS
  • NPI 1619778586
  NPD
• Eastern Shore Urgent Care LLC

  • Urgent Care Clinic/Center
  • Chestertown, MD
  • NPI 1548924988
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• State of Mississippi - University of Mississippi Medical Center

  • General Acute Care Hospital
  • Jackson, MS
  • NPI 1154317527
  Care Compare affiliation

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

{
    "created_epoch": "1326672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326672000000",
    "number": "1992076467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3719 DAUPHIN ST",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366081753",
            "telephone_number": "251-460-5333",
            "fax_number": "251-460-5295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3719 DAUPHIN ST",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366081753",
            "telephone_number": "251-460-5333",
            "fax_number": "251-460-5295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NETTLES",
        "first_name": "KENNA",
        "middle_name": "HOGUE",
        "credential": "PA-C, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-01-16",
        "last_updated": "2012-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "PA788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENNA",
            "last_name": "HOGUE",
            "middle_name": "LAINE",
            "credential": "ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mary Kathryn Neno, RN
• Nephrology Associates of Mobile, P.a.
• David Nery, M.D.
• Gilaine Nettles, RPT
• Jennefer Jeanette Nettles
• Marquita Peters Nettles, PMHNP
• Alfred Miles Neumann Jr., M.D.
• Neurology Child and Adult PC
• Neverfails
• Phil Charles Neville

• Physician Assistant in Mobile, AL
• Providers in Mobile, AL by specialty
• Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2012; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.