DR. BRENT D KENNEDY (NPI# 1174747109) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1174747109 |
Entity Type | Individual |
Full Name | DR. BRENT D KENNEDY |
Credential | M.D. |
Practice Address |
5929 Fashion Blvd Murray UT 84107-7364 |
Practice Telephone | 8012613637 |
Practice Fax Number | 8012614096 |
Mailing Telephone | 8012613637 |
Mailing Fax Number | 8012614096 |
Enumeration Date | 2007-04-12 |
Last Update Date | 2012-11-12 |
Gender Code | M |
Is Sole Proprietor | Y |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 174400000X | Specialist | 0714510013 | UT | Other Service Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
UT | STATE LICENSE | 0714510013 | 01 |
UT | FEDERAL TAX ID | 870503471 | 01 |
UT | SPECIALTY LICENSE | AK7813048 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1295855112 | Brent Sheldon Kennedy | Physical Therapist | 3715 Woodking Dr, Idaho Falls, ID 83404-4720 | 2007-04-02 |
Street Address |
5929 FASHION BLVD |
City | MURRAY |
State | UT |
Zip Code | 84107-7364 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1265656227 | Institute of Facial Surgery | Clinic/Center | 5929 Fashion Blvd, Murray, UT 84107-7364 | 2007-04-12 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1902410517 | Brielle Nicole Poulter | Student in an Organized Health Care Education/Training Program | 345 East 4500 So #260, Murray, UT 84107 | 2020-09-01 |
1467016592 | Ashlee Brown | Social Worker | C-134, 5284 Commerce Drive, Murray, Murray, UT 84107 | 2019-04-24 |
1568940633 | Samantha Duff | Occupational Therapist | 5770 S Fashion Blvd, Bldg 5 Ste 201, Murray, UT 84107 | 2018-08-01 |
1881185247 | Derek John Sharp | Occupational Therapist | 5770 S Fashion Blvd, Bldg #5, Suite 210, Murray, UT 84107 | 2018-05-22 |
1093223091 | Erin Nicole Hill | Counselor | 345 East 4500 South Suite 260, Murray, UT 84107 | 2018-01-12 |
1588171219 | Nicole Danielle Jensen | Counselor | 345 East 4500 South, Suite 260, Murray, UT 84107 | 2018-01-03 |
1043725799 | Greater Endodontics LLC | Dentist | 5334 South Woodrow Street, Suite 201, Salt Lake City, UT 84107 | 2017-12-04 |
1043739667 | Karyn K Hodge | Audiologist | 4500 So. 777. E. Ste #110, Murray, UT 84107 | 2017-09-14 |
1912426750 | Brandon C Burton | Specialist/Technologist, Other | Cta Community Supports 4444 S, 700 E Suite 203, Salt Lake City, UT 84107 | 2017-09-13 |
1396261152 | Megan Lehane Delano | Plastic Surgery | 5169 Cottonwood St Ste 420, Murray, UT 84107 | 2017-08-14 |
Find all providers in zip 84107 |
Taxonomy Code | 174400000X |
Grouping | Other Service Providers |
Classification | Specialist |
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1356732366 | Chad Beckstead | Specialist | 4500 S 700 E Ste 203, Murray, UT 84107-3075 | 2015-02-12 |
1265653521 | Stacey M. Lawson | Specialist | 2209 Quail Creek Dr, Murray, KY 42071-2728 | 2007-05-02 |
1427171560 | Hl Hearing, Inc | Specialist | 5261 S State St, Murray, UT 84107-4828 | 2007-04-06 |
1508928763 | Sherman G Sorensen Md | Specialist | 5169 Cottonwood Street, Suite 610, Murray, UT 84107-5701 | 2006-12-14 |
1386737096 | Wasatch Neurological Clinic | Specialist | 6040 S. Fashion Blvd, #201, Murray, UT 84107 | 2006-10-02 |
1376566109 | Richard H. Stout | Specialist | 2957 Us Highway 641 N, Murray, KY 42071-7840 | 2006-07-25 |
1073557583 | Nathan B Eliason | Specialist | 677 W 5300 S, Murray, UT 84123-5671 | 2006-06-15 |
1881633733 | Toni L Tilton | Specialist | 1659 Ryan Ave, Murray, KY 42071-1768 | 2006-06-06 |
1609823426 | Mark A. Rosen | Specialist | 5911 Fashion Blvd, Suite 100, Murray, UT 84107-7352 | 2006-05-27 |
1063485977 | William Lewis Giese | Specialist | 204 S 9th St, Suite B, Murray, KY 42071-2409 | 2006-02-10 |
Find all providers in MURRAY |
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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.