| The Kennedy Clinic Pllc | |
|
4957 Swinyar Dr Ste 109 Ooltewah TN 37363-2205 | |
| (423) 396-9893 | |
| (423) 396-9508 |
| Full Name | The Kennedy Clinic Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4957 Swinyar Dr Ste 109, Ooltewah, Tennessee |
| Authorized Official Name and Position | Howard Michael Kennedy (MANAGING MEMBER) |
| Authorized Official Contact | 4234323130 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Kennedy Clinic Pllc 4957 Swinyar Dr Suite 109 Ooltewah TN 37363 Ph: (423) 432-3130 | The Kennedy Clinic Pllc 4957 Swinyar Dr Ste 109 Ooltewah TN 37363-2205 Ph: (423) 396-9893 |
| NPI Number | 1508078445 |
|---|---|
| Provider Enumeration Date | 05/04/2007 |
| Last Update Date | 09/12/2024 |
| Medicare PECOS PAC ID | 2769574219 |
|---|---|
| Medicare Enrollment ID | O20070828000948 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508078445 | NPI | - | NPPES |
| 1942280052 | Other | TN | KENNEDY NPI# |
| 413276426 | Other | TN | KENNEDY SS# |
| 4136940 | Other | TN | KENNEDY BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Lloyd J Rimer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1902844772 PECOS PAC ID: 6901871946 Enrollment ID: I20051013000986 |
| Provider Name | Janice A Burgess |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548343387 PECOS PAC ID: 9335172055 Enrollment ID: I20100324000776 |
| Provider Name | Casey R Kepner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598073561 PECOS PAC ID: 6002096278 Enrollment ID: I20110204000265 |
| Provider Name | Christopher S Chandler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851693360 PECOS PAC ID: 4587841465 Enrollment ID: I20110601000448 |
| Provider Name | Ronda L Huisman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194943449 PECOS PAC ID: 3870750946 Enrollment ID: I20120131000930 |
| Provider Name | Katherine Dodd |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790068187 PECOS PAC ID: 4789840505 Enrollment ID: I20120724000215 |
| Provider Name | Michael E Hill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104168327 PECOS PAC ID: 9234376963 Enrollment ID: I20130516000272 |
| Provider Name | Deirdre Ensley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083814222 PECOS PAC ID: 7416181037 Enrollment ID: I20131014000820 |
| Provider Name | Donna R Duff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598191025 PECOS PAC ID: 3476781170 Enrollment ID: I20131231001463 |
| Provider Name | Tamisha Pena |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235546888 PECOS PAC ID: 8628299377 Enrollment ID: I20141021001857 |
| Provider Name | Melissa M Stuntz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154753929 PECOS PAC ID: 0547482499 Enrollment ID: I20150604001738 |
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