KENNETT PEDIATRICS AND ADOLESCENTS MEDICINE LLC (NPI# 1063414704) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063414704 |
| Entity Type | Organization |
| Organization Name | KENNETT PEDIATRICS AND ADOLESCENTS MEDICINE LLC |
| Practice Address |
211 Teaco Rd Kennett MO 63857-3236 |
| Mailing Address |
Po Box 908 Kennett MO 63857-0908 |
| Practice Telephone | 5738880001 |
| Practice Fax Number | 5738880006 |
| Mailing Telephone | 5738880001 |
| Mailing Fax Number | 5738880006 |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2014-05-16 |
| Authorized Official Name | ANDREW C BEACH (MD OWNER) |
| Authorized Official Telephone | 5738880001 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | ========= | MO | Allopathic & Osteopathic Physicians |
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 599371408 | 05 |
| Street Address |
211 TEACO RD |
| City | KENNETT |
| State | MO |
| Zip Code | 63857-3236 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164423935 | Andrew C Beach | Pediatrics | 211 Teaco Rd, Kennett, MO 63857-3236 | 2005-08-03 |
| 1033689864 | Brittnay Mossman | Nurse Practitioner | 211 Teaco Rd, Kennett, MO 63857-3236 | 2018-12-05 |
| 1619444627 | Kimberly Ellen Slayton | Nurse Practitioner | 211 Teaco Rd, Kennett, MO 63857-3236 | 2018-10-29 |
| 1497282974 | Shawn Michelle Waugh | Nurse Practitioner | 211 Teaco Rd, Kennett, MO 63857-3236 | 2017-05-16 |
| 1629511415 | Kennett Pediatrics and Asolescents Medicine LLC | Family Medicine | 211 Teaco Rd, Kennett, MO 63857-3236 | 2016-11-28 |
| 1083167522 | Ginger L Smith | Nurse Practitioner | 211 Teaco Rd, Kennett, MO 63857-3236 | 2016-08-02 |
| 1801224407 | Lori E Parker | Clinical Nurse Specialist | 211 Teaco Rd, Kennett, MO 63857-3236 | 2013-10-17 |
| 1780859512 | Kennett Pediatric | Pediatrics | 211 Teaco Rd, Kennett, MO 63857-3236 | 2008-04-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992278139 | Fancilla Adams | Counselor | 925 State Highway V V, Kennett, MO 63857 | 2019-01-10 |
| 1962994418 | Kiana Alexis Brown | Behavior Technician | 925 Highway W, Kennett, MO 63857 | 2018-05-31 |
| 1568953636 | Doctors Health Group, Inc | Family Medicine | 1312 First Street, Kennett, MO 63857 | 2018-05-24 |
| 1003328873 | Ann Graf | Counselor | 925 Vv, Kennett, MO 63857 | 2017-11-01 |
| 1457872160 | Jessica Luster | Technician, Other | 1109 Jones St., Kennett, MO 63857 | 2017-07-03 |
| 1235669128 | Chandra Celeste Perkins-shannon | Case Manager/Care Coordinator | 925 Hwy V, Kennett, MO 63857 | 2017-06-14 |
| 1467991612 | Sarah Lobdell | Case Manager/Care Coordinator | 925 State Highway Vv, Kennett, MO 63857 | 2017-02-21 |
| 1881132900 | Brandy Rios | Community Health Worker | 935 State Hwy Vv, Kennett, MO 63857 | 2017-02-09 |
| 1295272060 | Johnny Marie Johnson | Case Manager/Care Coordinator | 925 Hwy Vv Family Counseling Center, Kennett, MO 63857 | 2017-01-31 |
| 1043756364 | Heather Bowman | Case Manager/Care Coordinator | 875 Hwy Vv, Kennett, MO 63857 | 2017-01-10 |
| Find all providers in zip 63857 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205387024 | Kennett Hma LLC | Clinic/Center | 1231 1st St, Kennett, MO 63857-2527 | 2016-10-17 |
| 1477821684 | Kennett Hma LLC | Clinic/Center | 1231 1st St, Suite 5, Kennett, MO 63857-2527 | 2011-12-02 |
| 1023342987 | Kennett Hma LLC | Clinic/Center | 509 South Byp, Kennett, MO 63857-3248 | 2009-09-25 |
| 1811166465 | Amy R Lockhert | Clinic/Center | 105 E Washington St, Kennett, MO 63857-2041 | 2008-02-28 |
| 1043363013 | Healthcare for Women, Inc. | Clinic/Center | 304 Teaco Rd, Suite G, Kennett, MO 63857-3266 | 2007-01-20 |
| 1992807390 | Pemiscot County Memorial Hospital | Clinic/Center | 304 Teaco Rd, Kennett, MO 63857 | 2006-09-05 |
| 1245271915 | Kennett Hma Inc | Clinic/Center | 1301 1st St, Kennett, MO 63857-2525 | 2006-06-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871102137 | Washington County Memorial Hospital | Clinic/Center | 14206 Hwy C, Belgrade, MO 63622 | 2020-07-23 |
| 1891325072 | Scotland County Memorial Hospital | Clinic/Center | 55682 State Highway 6 Ste A, Edina, MO 63537-4268 | 2020-01-16 |
| 1639736457 | Southeast Health Center of Stoddard County LLC | Clinic/Center | 800 Us Highway 61, New Madrid, MO 63869-1106 | 2019-05-28 |
| 1134633456 | Pike County Memorial Hospital | Clinic/Center | 1420 S Business 61 Unit Fde, Bowling Green, MO 63334-5230 | 2017-11-22 |
| 1720505894 | Perry County Health System | Clinic/Center | 210 Hospital Ln Ste 202, Perryville, MO 63775-4200 | 2017-08-29 |
| 1427572007 | Missouri Delta Medical Center | Clinic/Center | 209 W Yoakum Ave, Chaffee, MO 63740-1138 | 2017-07-26 |
| 1790213676 | Jackson Primary Care LLC | Clinic/Center | 2685 E Main St Ste A, Jackson, MO 63755-2474 | 2017-05-23 |
| 1972050581 | Sgoh Acquisition, Inc. | Clinic/Center | 912b State Highway 59, Goodman, MO 64843-8252 | 2016-09-01 |
| 1144605312 | Nevada City Hospital | Clinic/Center | 627 S Ash St Ste B, Nevada, MO 64772 | 2015-07-29 |
| 1669856829 | Ssm Regional Health Services | Clinic/Center | 2511 W Edgewood Dr Ste F, Jefferson City, MO 65109-5869 | 2015-07-16 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on KENNETT PEDIATRICS AND ADOLESCENTS MEDICINE LLC.
| 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.