VIRGINIA MAE KENNEDY (NPI# 1689141103) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689141103 |
| Entity Type | Individual |
| Full Name | VIRGINIA MAE KENNEDY |
| Credential | CDPT |
| Practice Address |
12200 Bordeaux Rd Little Rock WA 98556 |
| Mailing Address |
1402 Harrison Ave Apt E116 Centralia WA 98531-4525 |
| Practice Telephone | 3603594075 |
| Mailing Telephone | 3602703115 |
| Enumeration Date | 2018-11-02 |
| Last Update Date | 2018-11-02 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
60537602 | WA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740667823 | Virginia Kennedy | Registered Nurse | 24622 Ross St, Dearborn, MI 48124-3147 | 2015-04-28 |
| 1316319304 | Virginia Kennedy | Social Worker | 165 Peppers Ferry Rd, Wytheville, VA 24382-2070 | 2015-10-29 |
| Street Address |
12200 BORDEAUX RD |
| City | LITTLE ROCK |
| State | WA |
| Zip Code | 98556 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255655387 | Lynn Ann Majors | Physician Assistant | 12200 Bordeaux Road, Cedar Creek Corrections Center, Littlerock, WA 98556-0037 | 2010-03-18 |
| 1750672572 | Cedar Creek Corrections Center | Clinic/Center | 12200 Bordeaux Road, Littlerock, WA 98556-0037 | 2011-04-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720689524 | Pain Treatment Centers of America, Pllc | Durable Medical Equipment & Medical Supplies | 9 Freeway Dr Ste B, Little Rock, AR 72204-2486 | 2020-11-06 |
| 1154922540 | Home Health Care Agency of Arkansas, LLC | Technician | 1200 John Barrow Rd Ste 111, Little Rock, AR 72205-6528 | 2020-11-03 |
| 1326647918 | Coco Psychiatric Services Pllc | Nurse Practitioner | 115 Bella Rosa Pl, Little Rock, AR 72223-4771 | 2020-10-23 |
| 1609475805 | Arkansas Health Group | Dietitian, Registered | 10915 Rodney Parham Road, Suite G, Little Rock, AR 72212 | 2020-10-20 |
| 1932707650 | Relymd Medical Group Ar, Pllc | Family Medicine | 1215 Twin Lakes Dr, Little Rock, AR 72205-6768 | 2020-10-14 |
| 1780282566 | Lauren Tilley | Surgery | 4301 W Markham St # 720, Little Rock, AR 72205-7101 | 2020-10-13 |
| 1538767462 | Safe Harbor Behavioral Health Pllc | Nurse Practitioner | 11401 N Rodney Parham Rd Ste 4, Little Rock, AR 72212-4168 | 2020-10-13 |
| 1437757630 | Kaylah Charles | Pediatrics | 36 Melinda Dr, Little Rock, AR 72209-3341 | 2020-10-12 |
| 1790382059 | Landmark Medical of Arkansas Pa | General Practice | 425 W Capitol Ave Ste 425, Little Rock, AR 72201-3424 | 2020-10-08 |
| 1629675285 | Orthoarkansas Spine Institute Procedure Center LLC | Clinic/Center | 800 Fair Park Blvd Ste 300, Little Rock, AR 72204-1720 | 2020-10-07 |
| Find all providers in LITTLE ROCK | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871158469 | Jerry Rushing | Counselor | 6301 Father Tribou St, Little Rock, AR 72205-3003 | 2019-05-08 |
| 1801223532 | Carolyn Denise Thomas | Counselor | 523 Louisiana St, , Suite 211, Little Rock, AR 72201-5712 | 2013-09-26 |
| 1922344340 | Yulonda Ross | Counselor | 6900 Scott Hamilton Dr, Little Rock, AR 72209-3144 | 2012-12-13 |
| 1861728602 | Jere Clifton Brewer | Counselor | 4301 W Markham St # 835, Little Rock, AR 72205-7101 | 2009-10-29 |
| 1558588590 | Tameka L Lancaster | Counselor | 900 S Shackleford Rd Ste 30, Little Rock, AR 72211-3817 | 2007-04-19 |
| 1396863700 | Eugene Robert Gerst Jr. | Counselor | 820 W 6th Street, Ste 200, Little Rock, AR 72201 | 2007-03-26 |
| 1518016450 | Arthur Wayne Chupik | Counselor | 1715 Pine Valley Rd, Little Rock, AR 72207-2605 | 2007-01-09 |
| 1659439248 | Family Counseling & Recovery Centers | Counselor | 7509 Cantrell Rd, Ste 213, Little Rock, AR 72207-2529 | 2006-12-05 |
| 1629167689 | Leslie P Smith | Counselor | 17 Woodhill Dr, Little Rock, AR 72211-3382 | 2006-10-11 |
| 1427038728 | Barbara Jo Franzen | Counselor | 10025 W. Markham St, Suite 210, Little Rock, AR 72205 | 2006-01-20 |
| Find all providers in LITTLE ROCK | ||||
| City | LITTLE ROCK |
| Zip Code | 98556 |
Please comment or provide details below to improve the information on VIRGINIA MAE 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.