Mark S Kennedy, ARNP-BC
Nurse Practitioner, Family in Neosho, MO. Individual provider (NPI-1).
NPI number1811028673
StatusActive
Last updated in NPPESOct 5, 2018
Details
- NPI
- 1811028673
- Entity type
- Individual (NPI-1)
- Name
- Mark S Kennedy
- Credential
- ARNP-BC
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 7, 2007
- Last updated
- Oct 5, 2018
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 141364 | MO | Yes |
| 363L00000X | Nurse Practitioner | 66851 | OK | |
| 363L00000X | Nurse Practitioner | 45922 | KS |
Practice location
1355 Rocketdyne RdNeosho, MO 64850-3106
Phone 417-451-7425 · Fax 417-451-7455
Mailing address
Po Box 4725Joplin, MO 64803-4725
Phone 417-451-7425 · Fax 417-451-7455
Other practice locations
510 Park St
Anderson, MO 64831-9280
Anderson, MO 64831-9280
Phone 417-845-0545 · Fax 417-845-0548
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 16 Family Nurse Practitioner providers in Neosho · All 335 providers in Neosho
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