MR. WARREN K KENNEDY (NPI# 1083898290) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083898290 |
| Entity Type | Individual |
| Full Name | MR. WARREN K KENNEDY |
| Credential | PA-C |
| Practice Address |
3420 Illinois St Great Lakes IL 60088-3120 |
| Mailing Address |
3420 Illinois Street Great Lakes ID 60088-1312 |
| Practice Telephone | 8476882522 |
| Mailing Telephone | 8476882522 |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2007-12-24 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629069307 | Warren Leigh Kennedy | Optometrist | 1401 Sylvan Ave, Modesto, CA 95355-1367 | 2005-11-02 |
| Street Address |
3420 ILLINOIS ST |
| City | GREAT LAKES |
| State | IL |
| Zip Code | 60088-3120 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952385148 | Jason Todd Holdeman | Psychologist | 3420 Illinois St, Great Lakes, IL 60088-3161 | 2005-12-01 |
| 1750851788 | Claire Kubiesa | Psychologist | 3420 Illinois St, Great Lakes, IL 60088-3161 | 2018-12-03 |
| 1003342536 | Emily J Baker | Physical Therapist | 3420 Illinois St, Great Lakes, IL 60088-3161 | 2017-05-03 |
| 1346603594 | Laura Megan Logeman | Physician Assistant | 3420 Illinois St, Great Lakes, IL 60088-3161 | 2016-04-04 |
| 1225407539 | Kevin O'connor | Physician Assistant | 3420 Illinois St, Great Lakes, IL 60088-3161 | 2015-09-16 |
| 1245595776 | Alma Teresa C Molino | Psychologist | 3420 Illinois St, Great Lakes, IL 60088-3161 | 2012-07-10 |
| 1245529304 | Erin Graham | Student in an Organized Health Care Education/Training Program | 3420 Illinois St, Bldg 1007, Great Lakes, IL 60088-3161 | 2011-03-29 |
| 1588895742 | Kermit Salivia | Family Medicine | 3420 Illinois St, Great Lakes, IL 60088-3161 | 2009-08-05 |
| 1346435112 | Jason Yungsup Kim | Family Medicine | 3420 Illinois St, Uss Tranquillity Clinic 1007, Great Lakes, IL 60088-3161 | 2007-09-13 |
| 1972793909 | Brett Staib | Military Health Care Provider | 3420 Illinois St, Bhc 1007, Great Lakes, IL 60088-3120 | 2007-07-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043858228 | Kathryn Ann Bird | Dentist | 3440 W Ohio St, Uss Osborne Branch Dental Clinic, Great Lakes, IL 60088 | 2019-12-18 |
| 1740775576 | Jonathan William Criter | Dentist | 3400 Ohio St, Great Lakes, IL 60088 | 2018-06-25 |
| 1134598733 | True Xiong | Dentist | Zachary & Elizabeth Fisher Medical & Dental Clinic, 2470 Sampson Street, Apo, AA 60088 | 2015-09-24 |
| 1447685771 | Lisa Carol Perrone | Dentist | Fhcc Lovell Bldg 237 Dental, Navsta Great Lakes, North Chicago, IL 60088 | 2013-09-05 |
| 1437438421 | David Lawrence Green | Dentist | 2410 Samson St., Bldg 237, Great Lakes, IL 60088 | 2011-08-09 |
| 1164730602 | James A Lovell Federal Health Care Center | Military/U.S. Coast Guard Pharmacy | 2430 Illinois Street, Great Lakes, IL 60088 | 2010-09-17 |
| 1598073439 | James A Lovell Federal Health Care Center | Military/U.S. Coast Guard Pharmacy | 2430 Illinois St, Bldg 1007, Great Lakes, IL 60088 | 2010-09-14 |
| 1164736302 | Clinton Lariscy | Military Health Care Provider | 3355 Illinois St, Recruit Training Command Great Lakes, Great Lakes, IL 60088 | 2010-07-29 |
| 1083943906 | James Doll | Dentist | 2608 Paul Jones St, Great Lakes, IL 60088 | 2009-12-24 |
| 1396996823 | Kelly Robert Lanning | Dentist | 3001 A 6th St Bhc 237, Naval Hospital Great Lakes- Dental Dept., Great Lakes, IL 60088 | 2008-10-02 |
| Find all providers in zip 60088 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770544835 | Jerome Thomas Campbell II | Physician Assistant | 3420 Illinois Street, Uss Tranquillity Medical Clinic, Great Lakes, IL 60088-5230 | 2006-03-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831707298 | Eliza Ballen | Physician Assistant | 335 Sylvan Rd, Lake Bluff, IL 60044-2562 | 2020-07-21 |
| 1477177947 | Rybecca Janovyak | Physician Assistant | 14432 High Rd, Lockport, IL 60441-9402 | 2020-06-01 |
| 1518591759 | Julie Jenkot | Physician Assistant | 333 N Michigan Ave Fl 14, Chicago, IL 60601-3901 | 2020-02-26 |
| 1801429873 | Hinjal D Jha | Physician Assistant | 22285 N Pepper Rd Ste 409, Lake Barrington, IL 60010-2542 | 2020-02-19 |
| 1770120222 | Alvina Shaikh | Physician Assistant | 4009 Warren Ave, Bellwood, IL 60104-2066 | 2019-12-03 |
| 1457997561 | Jasleen Mohini Singh | Physician Assistant | 1645a W School Street, Suite A, Clinic Entrance, Chicago, IL 60657 | 2019-11-24 |
| 1538705272 | Bethany Mae Frisby | Physician Assistant | 8630 W Golf Rd, Niles, IL 60714-5600 | 2019-11-18 |
| 1134761984 | Ella-marie Rakowski | Physician Assistant | 25 Acorn Dr, Hawthorn Woods, IL 60047-7407 | 2019-10-14 |
| 1467001859 | Timothy Omotayo Adesanya | Physician Assistant | Graham Correctional Center, 12078 Illinois Rte 185, Hilliboro, IL 62049 | 2019-09-09 |
| 1518514066 | Victoria Moore | Physician Assistant | 979 W Main St, West Dundee, IL 60118-2088 | 2019-08-20 |
| Find all providers with the same taxonomy | ||||
| City | GREAT LAKES |
| Zip Code | 60088 |
Please comment or provide details below to improve the information on MR. WARREN K KENNEDY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.