Criswell Allen Kennedy, MD is a medicare enrolled "General Practice" physician in Liberty Lake, Washington. His current practice location is
24128 E Alki Ln, Liberty Lake, Washington. You can reach out to his office (for appointments etc.) via phone at
(509) 255-5065.
Criswell Allen Kennedy is licensed to practice in Washington (license number MD00017804) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1912122847.
Physician's Profile
Full Name | Criswell Allen Kennedy |
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Gender | Male |
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Speciality | General Practice |
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Location | 24128 E Alki Ln, Liberty Lake, Washington |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1912122847
- Provider Enumeration Date: 04/16/2007
- Last Update Date: 07/08/2007
Medicare PECOS Information:
- PECOS PAC ID: 4385937879
- Enrollment ID: I20160720002979
Medical Identifiers
Medical identifiers for Criswell Allen Kennedy such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1912122847 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
208D00000X | General Practice | MD00017804 (Washington) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Criswell Allen Kennedy is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Criswell Allen Kennedy, MD 24128 E Alki Ln, Liberty Lake, WA 99019-9447 Ph: (509) 255-5065 | Criswell Allen Kennedy, MD 24128 E Alki Ln, Liberty Lake, WA 99019-9447 Ph: (509) 255-5065 |
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