1841492568 NPI number — KEVIN D KENNEDY PT

Table of content: DR. MARILYN BRITTON D.C. (NPI 1760418909)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841492568 NPI number — KEVIN D KENNEDY PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENNEDY
Provider First Name:
KEVIN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841492568
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 N STATE ST
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39202-1689
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-944-1717
Provider Business Mailing Address Fax Number:
601-944-9780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 N STATE ST
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39202-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-352-2273
Provider Business Practice Location Address Fax Number:
601-714-3415
Provider Enumeration Date:
06/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT3757 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04139874 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00410919 . This is a "RR MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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