Active NPI
Julie Lynn Kennedy-Rea
- Professional Counselor
- Bridgeport, WV
National Provider Identifier
1992364202
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 1093
- Practice address
- 27 Trovato St Ste 103
Bridgeport, WV 26330-7286 - Phone
- (304) 623-6300
- NPI assigned
- Jun 10, 2019
- 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 1093 | WV | Primary |
Addresses
Primary practice location
27 Trovato St Ste 103
Bridgeport, WV 26330-7286
Mailing address
3245 Mount Clare Rd
Clarksburg, WV 26301-7458
Phone (304) 677-8564
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1093 | WV | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560124800000",
"number": "1992364202",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3245 MOUNT CLARE RD",
"city": "CLARKSBURG",
"state": "WV",
"postal_code": "263017458",
"telephone_number": "304-677-8564"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27 TROVATO ST STE 103",
"city": "BRIDGEPORT",
"state": "WV",
"postal_code": "263307286",
"telephone_number": "304-623-6300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENNEDY-REA",
"first_name": "JULIE",
"middle_name": "LYNN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-06-10",
"last_updated": "2019-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "WV",
"license": "1093",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.