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DR. ALEXANDRA RICKER KENNEDY DDS, MS
NPI 1891347951
Dentist - Periodontics in Tyler, TX

Active since July 09, 2019PECOS Enrolled
3805 BROOKSIDE DR, TYLER, TX 75701(903) 581-2900(903) 509-0160 Get Directions Write a Review

NPPES record last updated: April 16, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Apr 16, 2024, Nov 29, 2022, Jul 9, 2019 (3 updates tracked since 2019).

About Dr. Alexandra Ricker Kennedy Dds, Ms NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ALEXANDRA RICKER KENNEDY DDS, MS (NPI 1891347951) is an individual periodontics provider in Tyler, Texas, licensed in Texas (35680) and active in the NPI registry since July 2019. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1891347951
Entity TypeIndividualFemale
Primary Taxonomy1223P0300X
Provider Legal NameDR. ALEXANDRA RICKER KENNEDYCredential: DDS, MS
Location Address3805 BROOKSIDE DRTyler, TX 75701-9421
Mailing Address3805 Brookside DrTyler, TX 75701-9421 · (903) 581-2900 · Fax (903) 509-0160
Phone(903) 581-2900
Fax(903) 509-0160
Sole ProprietorYes
Enumeration DateJuly 9, 2019
Last NPPES UpdateApril 16, 20243 updates tracked since enumeration
NPPES CertifiedApril 16, 2024
✔ NPI 1891347951 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · PeriodonticsDental Providers
Taxonomy Code1223P0300X
License✔ Licensed in TX · 35680
Definition

That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.

3805 BROOKSIDE DR, Tyler, TX 75701
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Other Names 1

Professional Name (2)Dr. Mary Alexandra Ricker Dds Ms

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Alexandra Ricker Kennedy Dds, Ms is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 75701 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$84.92 typical visit price
range $54.84 – $166.88
Typical copayment $21.23 (range $13.71 – $41.72)
Most-billed visit code 99203
Established Patient
$68.55 typical visit price
range $17.52 – $136.11
Typical copayment $17.13 (range $4.38 – $34.02)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TYLER PERIODONTICS, PLLC
Dentist (Periodontics)
3805 BROOKSIDE DR
TYLER, TX 75701
Smith County (903) 581-2900
DR. JOHN E. ADCOCK D.D.S., M.S.
Dentist (Periodontics)
3805 BROOKSIDE DR
TYLER, TX 75701
Smith County (903) 288-8805

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Alexandra Kennedy's NPI number?

The NPI number for Alexandra Kennedy is 1891347951. It was assigned to this individual provider in the NPPES registry on July 9, 2019. The provider is also known as Dr. Mary Alexandra Ricker Dds Ms.

Where is Alexandra Kennedy located?

Alexandra Kennedy practices at 3805 Brookside Dr, Tyler, TX 75701. The listed phone number is (903) 581-2900.

What is Alexandra Kennedy's specialty?

The primary specialty registered for this NPI is Dentist, specializing in Periodontics, with taxonomy code 1223P0300X.

Is Alexandra Kennedy enrolled in Medicare?

Yes. Alexandra Kennedy is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Alexandra Kennedy was last updated on April 16, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.