DR. SAMANTHA FUGATE KENNEDY (NPI# 1154760312) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1154760312 |
Entity Type | Individual |
Full Name | DR. SAMANTHA FUGATE KENNEDY |
Other Name | SAMANTHA ANN FUGATE |
Credential | D.O. |
Practice Address |
909 Fee Rd Ste B119 East Lansing MI 48824 |
Mailing Address |
804 Service Rd # A109f East Lansing MI 48824-7015 |
Practice Telephone | 5173533070 |
Practice Fax Number | 5174323603 |
Mailing Telephone | 5178842976 |
Mailing Fax Number | 5174323928 |
Enumeration Date | 2013-06-21 |
Last Update Date | 2018-06-25 |
Gender Code | F |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
5101020751 | MI | Allopathic & Osteopathic Physicians |
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1578081451 | Samantha Kennedy | Speech-Language Pathologist | 31 E Park Dr, Old Bethpage, NY 11804 | 2017-08-31 |
1588919286 | Samantha Lou Kennedy | Chiropractor | 5300 Edgewood Rd Ne Ste 200, Cedar Rapids, IA 52411-4706 | 2012-07-18 |
1952938896 | Samantha Kennedy | Counselor | 129 Hedin Ave, Red Wing, MN 55066-1907 | 2020-03-23 |
1689232506 | Samantha Tarantino Kennedy | Student in an Organized Health Care Education/Training Program | 13535 Nemours Pkwy, Orlando, FL 32827-7402 | 2019-06-05 |
1588049415 | Samantha Leigh Kennedy | Psychologist | 400 W Mineral King Ave, Visalia, CA 93291 | 2015-07-21 |
1558771824 | Samantha Kennedy | Counselor | 5115 F St, Omaha, NE 68117-2807 | 2014-05-07 |
1073940532 | Samantha Kennedy | Specialist/Technologist | 329 Mullet Run, Milford, DE 19963-5373 | 2013-09-30 |
Street Address |
909 FEE RD STE B119 |
City | EAST LANSING |
State | MI |
Zip Code | 48824 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1528680303 | Emilia Elizabeth Mattioli | Psychiatry & Neurology | 965 Fee Road Room A223, East Lansing, MI 48824 | 2020-05-14 |
1447871983 | James O'brien | Psychiatry & Neurology | Msu Psychiatry Residency Program, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2020-05-06 |
1750916979 | Mulin Xiong | Student in an Organized Health Care Education/Training Program | 965 Wilson Road Suite A110, East Fee Hall, East Lansing, MI 48824 | 2020-03-09 |
1821659301 | Tovah Apolonia Aho | Psychiatry & Neurology | Michigan State University Psychiatric Residency, 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-06-25 |
1912564881 | Asmara Theresa Hoo | Psychiatry & Neurology | 965 Fee Road, Room A233, East Lansing, MI 48824 | 2019-05-24 |
1790276822 | Traverse Health Clinic and Coalition | Clinic/Center | East Fee Hall 965 Fee Road, Room A222, East Lansing, MI 48824 | 2018-05-24 |
1922598515 | Jubin Joseph Cheruvelil | Specialist/Technologist, Other | 446 W. Circle Dr. Room 249 Annex, Justin S. Morrill Hall of Agriculture, East Lansing, MI 48824 | 2018-05-18 |
1073003257 | Dawn Arvye Contreras | Health Educator | 446 West Circle Dr., Justin S. Morrill Hall of Agriculture, Room 166, East Lansing, MI 48824 | 2018-05-14 |
1710406046 | Kimberly Ann Breukink | Social Worker | 463 East Circle Drive, Michigan State University, Counseling and Psychiatric Services, East Lansing, MI 48824 | 2017-09-19 |
1043766314 | Ahmed Jouan | Psychiatry & Neurology | 804 Service Rd A217, East Lansing, MI 48824 | 2016-08-28 |
Find all providers in zip 48824 |
Taxonomy Code | 2084P0804X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Psychiatry & Neurology |
Specialization | Child & Adolescent Psychiatry |
Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1629416169 | Shady S Shebak | Psychiatry & Neurology | 965 Fee Rd, Room A233 East Fee Hall, East Lansing, MI 48824-6410 | 2013-06-06 |
1902981103 | Leslie Greene Macauley | Psychiatry & Neurology | 4970 Northwind Dr, East Lansing, MI 48823-5080 | 2006-10-26 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1316376056 | Esmaeil Emami | Psychiatry & Neurology | 2955 Franklin Rd, Bloomfield Hills, MI 48302-0917 | 2013-11-04 |
1407199961 | David Donald Krohn | Psychiatry & Neurology | 563 Highland Park Dr, Traverse City, MI 49686-2863 | 2013-04-03 |
1164712055 | Tatjana Maric | Psychiatry & Neurology | 420 Baltimore Dr Ne, Grand Rapids, MI 49503-3934 | 2011-04-12 |
1972893824 | Katherine Barbara Krive | Psychiatry & Neurology | 801 S Waverly Rd Ste 100, Lansing, MI 48917-4200 | 2011-04-12 |
1104128602 | Hope Network Behavioral Health Services | Psychiatry & Neurology | 3361 36th Street, Grand Rapids, MI 49512 | 2010-12-03 |
1295056653 | Veronica Yap Tan | Psychiatry & Neurology | 23354 Portage Way, Apt. 2212, Novi, MI 48375 | 2010-06-18 |
1548588874 | Katie Alanna Keller | Psychiatry & Neurology | 79 Alexandrine West, Detroit, MI 48201 | 2010-05-11 |
1538390133 | Behavioral Health Associates Pllc | Psychiatry & Neurology | 19500 Middlebelt Rd, Suite 350e, Livonia, MI 48152-2196 | 2009-07-30 |
1235375775 | Kristine Baker | Psychiatry & Neurology | 721 Cherokee St, Traverse City, MI 49684-1401 | 2009-01-06 |
1689820078 | Margaret Mary Casey | Psychiatry & Neurology | 1326 Saint Antoine St, Detroit, MI 48226-2301 | 2008-08-18 |
Find all providers with the same taxonomy |
City | EAST LANSING |
Zip Code | 48824 |
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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.