Richard C. Kennerly, PH.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

4561 Issued in NC

Practice address

170 Davidson Hwy Ste 201
Concord, NC 28027-4255

Phone

(704) 659-3541

Fax

(888) 977-3202

NPI assigned

Nov 6, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Carolina Behavioral Medicine, PA

  • Psychologist
  • Concord, NC
  • NPI 1891193918
  NPD Authorized official
• Psychiatric Centers at San Diego, Inc. Med GRP

  • Mental Health Counselor
  • San Diego, CA
  • NPI 1841241585

  Psychologist

  NPD (past)

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

{
    "created_epoch": "1225929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576454400000",
    "number": "1992959761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 DAVIDSON HWY STE 106",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280274246",
            "telephone_number": "704-659-3541",
            "fax_number": "888-977-3202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 DAVIDSON HWY STE 201",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280274255",
            "telephone_number": "704-659-3541",
            "fax_number": "888-977-3202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNERLY",
        "first_name": "RICHARD",
        "middle_name": "C.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-11-06",
        "last_updated": "2019-12-16",
        "certification_date": "2019-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY 22288",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NC",
            "license": "4561",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY 22288",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "4561",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY22288",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "NC",
            "license": "4561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leighton Margaret Kennedy, D.M.D.
• Lydia Scarlet Kennedy
• Megan Kennedy, ED.S, M.ED, NCC
• Robeert Alan Kennedy
• Ryan John Kennedy, DNP, FNP-C, PMHS
• Shannon Marie Kenny
• Matthew Raymond Kern, MA, LPC-A
• India Kerns
• Kerr Drug Inc
• Kerr Drug Inc

• Clinical Neuropsychologist in Concord, NC
• Providers in Concord, NC by specialty
• Clinical Neuropsychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 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.

Verify at the official NPI Registry.