PRO OF KENNETT, INC. (NPI# 1811108608) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811108608 |
| Entity Type | Organization |
| Organization Name | PRO OF KENNETT, INC. |
| Practice Address |
306 Recovery Rd Kennett MO 63857-3267 |
| Practice Telephone | 5738889190 |
| Practice Fax Number | 5738889404 |
| Mailing Telephone | 5738889190 |
| Mailing Fax Number | 5738889404 |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2007-11-15 |
| Authorized Official Name | MRS. TENA R. VANDEVENTER (OFFICE MANAGER) |
| Authorized Official Telephone | 5738889190 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 174400000X | Specialist | 02042 | MO | Other Service Providers |
| N | 174400000X | Specialist | 01506 | MO | Other Service Providers |
| N | 235Z00000X | Speech-Language Pathologist | 107027 | MO | Speech, Language and Hearing Service Providers |
| Y | 174400000X | Specialist | R0582 | MO | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| INDIVIDUAL NPI # | 1710935176 | 01 | |
| INDIVIDUAL NPI # | 1205884335 | 01 | |
| INDIVIDUAL NPI # | 1144278201 | 01 | |
| INDIVIDUAL NPI # | 1639127186 | 01 |
| Street Address |
306 RECOVERY RD |
| City | KENNETT |
| State | MO |
| Zip Code | 63857-3267 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205884335 | Audie Padrones | Specialist | 306 Recovery Rd, Kennett, MO 63857-3267 | 2006-05-04 |
| 1710935176 | Judy Britton | Speech-Language Pathologist | 306 Recovery Rd, Kennett, MO 63857-3267 | 2006-05-05 |
| 1639127186 | William Fredrick Palmer | Specialist | 306 Recovery Rd, Kennett, MO 63857-3267 | 2006-05-05 |
| 1144278201 | Thomas Hooper | Specialist | 306 Recovery Rd, Kennett, MO 63857-3267 | 2006-05-04 |
| 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 | 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 |
|---|---|---|---|---|
| 1598826992 | Ted W Duensing Do Ltd | Specialist | 1231 1st St, Suite 4, Kennett, MO 63857-2527 | 2006-12-12 |
| 1205884335 | Audie Padrones | Specialist | 306 Recovery Rd, Kennett, MO 63857-3267 | 2006-05-04 |
| 1184695934 | Soros Tungsiripat | Specialist | 604 Teaco Rd, Kennett, MO 63857-3724 | 2006-01-30 |
| 1780206185 | Marcus Owens | Specialist | 925 Highway Vv, Kennett, MO 63857 | 2020-05-08 |
| 1619337375 | Christopher Ray | Specialist | 925 Highway Vv, Kennett, MO 63857 | 2016-02-24 |
| 1730544412 | Lori Hicks | Specialist | 925 Highway Vv, Kennett, MO 63857-0071 | 2015-12-22 |
| 1932585197 | Brooke Reed | Specialist | 1109 Jones St, Kennett, MO 63857-3824 | 2015-08-10 |
| 1639127186 | William Fredrick Palmer | Specialist | 306 Recovery Rd, Kennett, MO 63857-3267 | 2006-05-05 |
| 1144278201 | Thomas Hooper | Specialist | 306 Recovery Rd, Kennett, MO 63857-3267 | 2006-05-04 |
| 1700880788 | Teodoro A Manubay | Specialist | 1312 1st St, Kennett, MO 63857-2526 | 2005-06-08 |
| Find all providers in KENNETT | ||||
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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.