MR. CHARLES REGGIE KENNEDY SR. (NPI# 1548583172) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1548583172 |
| Entity Type | Individual |
| Full Name | MR. CHARLES REGGIE KENNEDY SR. |
| Credential | CERTIFIED ORTHOTIST |
| Practice Address |
777 Lakeland Dr Jackson MS 39216-4611 |
| Mailing Address |
503 Cedar St Mize MS 39116-5572 |
| Practice Telephone | 6018154844 |
| Mailing Telephone | 6017332327 |
| Enumeration Date | 2010-03-10 |
| Last Update Date | 2010-03-10 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 222Z00000X | Orthotist | C0004097 | MS | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124455985 | Charles Kennedy Jr. | Specialist | 8454 Northview Pass, Fair Oak Ranch, TX 78015 | 2013-10-10 |
| 1942576111 | Charles Derensbough Kennedy | Internal Medicine | 229 Sycamore Grove St, Simi Valley, CA 93065-7342 | 2012-03-31 |
| 1902981624 | Charles A Kennedy | Social Worker | 4120 N 20th St Ste B, Phoenix, AZ 85016-6022 | 2006-10-25 |
| 1750485116 | Charles Reed Kennedy | Psychologist | 112 Holland Ave, Albany, NY 12208-3404 | 2006-09-07 |
| 1124477708 | Charles Kennedy | Student in an Organized Health Care Education/Training Program | 500 Cherry St, Bluefield, WV 24701-3306 | 2016-06-06 |
| 1467824425 | Charles T. Kennedy Jr. | Social Worker | 1309 S Linden Rd Ste C, Flint, MI 48532-3443 | 2015-10-29 |
| 1730320805 | Charles M Kennedy | Counselor | 171 Sw Court St, Dallas, OR 97338-3112 | 2009-03-18 |
| 1528260130 | Charles J Kennedy | Psychologist | 214 College Park Plz, Johnstown, PA 15904-2833 | 2007-06-05 |
| 1790896199 | Charles A. Kennedy | Dentist | 1000 Parkway Rd, South Charleston, WV 25309-9418 | 2006-08-31 |
| 1912984428 | Charles C Kennedy | Internal Medicine | 200 1st St Sw, Rochester, MN 55905-0001 | 2005-12-27 |
| Street Address |
777 LAKELAND DR |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4611 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538258736 | Rick A Psonak | Orthotist | 777 Lakeland Dr, Jackson, MS 39216-4611 | 2006-10-12 |
| 1497126775 | Damon Bagley-ayres | Orthotist | 777 Lakeland Dr, Jackson, MS 39216-4611 | 2015-10-13 |
| 1790091411 | April Webb | Speech-Language Pathologist | 777 Lakeland Dr, Jackson, MS 39216-4611 | 2010-08-19 |
| 1285956482 | Michelle Andrea Lowrie | Speech-Language Pathologist | 777 Lakeland Dr, Jackson, MS 39216-4611 | 2010-02-16 |
| 1487806899 | Josephine Pillow Duke | Speech-Language Pathologist | 777 Lakeland Dr, Jackson, MS 39216-4611 | 2008-10-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 222Z00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Orthotist |
| A health care professional who is specifically educated and trained to manage comprehensive orthotic patient care, including musculoskeletal and neuromuscular anomalies resulting from injuries or disease processes involving the lower extremity, upper extremity or spinal segment/s and positional deformation of the cranium. Orthotists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003338898 | Joshua Paul Ahlstrom | Orthotist | 1407 E Michigan Ave, Jackson, MI 49202-3517 | 2017-07-12 |
| 1477894848 | Duane R Hoeppner | Orthotist | 1005 E Michigan Ave, Jackson, MI 49201-2405 | 2013-03-11 |
| 1538258736 | Rick A Psonak | Orthotist | 777 Lakeland Dr, Jackson, MS 39216-4611 | 2006-10-12 |
| 1184149551 | David Trevisan | Orthotist | 1407 E Michigan Ave, Jackson, MI 49202-3517 | 2017-08-07 |
| 1497126775 | Damon Bagley-ayres | Orthotist | 777 Lakeland Dr, Jackson, MS 39216-4611 | 2015-10-13 |
| 1588035257 | Stephen Bret Lee | Orthotist | 2500 N State St, Jackson, MS 39216-4500 | 2015-10-07 |
| 1417362849 | Amy R Adcox | Orthotist | 2500 N State St, Jackson, MS 39216-4500 | 2014-06-24 |
| 1679916183 | Zachary Douglas Myrick | Orthotist | 2 Old River Pl Ste D, Jackson, MS 39202-3435 | 2013-04-15 |
| 1952586786 | Kevin Scribner | Orthotist | 2500 N State St, Jackson, MS 39216-4500 | 2007-12-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740823178 | Altair Incorporated | Orthotist | 4388 Leisure Time Dr, Diamondhead, MS 39525-3241 | 2019-10-17 |
| 1659869048 | Alberto L Alvarez | Orthotist | 3506 Washington Ave Ste D, Gulfport, MS 39507-3102 | 2018-05-01 |
| 1750833786 | William J. Kenny | Orthotist | 4201 Highway 11 N Ste D, Picayune, MS 39466-2014 | 2016-10-25 |
| 1902393614 | William K Wade | Orthotist | 3004 Bienville Blvd, Ocean Springs, MS 39564-4370 | 2018-04-18 |
| 1093763005 | Andrew S Kirby | Orthotist | 2323 5th St N, Columbus, MS 39705-2213 | 2006-05-04 |
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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.