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Donald Louis Kennedy

Psychiatry & Neurology

Allopathic & Osteopathic Physicians

3181 SW Sam Jackson Park Rd # L-579, Portland, OR 97239-3011

PECOS Enrollment

This provider is enrolled in PECOS as DONALD KENNEDY.

Based on the most recent information from CMS, provider Donald Louis Kennedy is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1073177630
Provider Type
Individual
Full Name
Kennedy, Donald Louis
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
4/29/2019
Last Updated
2/14/2024

Contact Information

Practice Location

3181 SW Sam Jackson Park Rd # L-579, Portland, OR 97239-3011

(503) 494-8311

Unlisted Fax

Mailing Location

3181 SW Sam Jackson Park Rd # L-579, Portland, OR 97239-3011

(503) 494-8311

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 2084P0800X Primary	Description Psychiatry & Neurology Allopathic & Osteopathic Physicians	License MD214747 Oregon
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer

Donald Louis Kennedy

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

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