MIRANDA KENNEDY
NPI 1902266992
Nurse Practitioner - Family in Rockford, IL

Q: What is Miranda Kennedy's NPI number?

The NPI number for Miranda Kennedy is 1902266992. It was assigned to this individual provider in the NPPES registry on March 3, 2016.

Q: What is Miranda Kennedy's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Miranda Kennedy was last updated on April 9, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 03, 2016PECOS Enrolled

2222 E STATE ST STE 209, ROCKFORD, IL 61104(815) 988-8500 Get Directions Write a Review

NPPES record last updated: April 9, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 9, 2019, Apr 1, 2019, Mar 3, 2016 (3 updates tracked since 2016).

On this page

About Miranda Kennedy NPPES

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

MIRANDA KENNEDY (NPI 1902266992) is an individual family provider in Rockford, Illinois, licensed in Illinois (209014174) and active in the NPI registry since March 2016. She is enrolled in Medicare PECOS and maintains a secondary practice location in Peoria.

NPPES Registry Identity

NPI1902266992

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameMIRANDA KENNEDY

Location Address2222 E STATE ST STE 209Rockford, IL 61104-1572

Mailing Address5405 N Knoxville AvePeoria, IL 61614-5016 · (309) 691-4410 · Fax (309) 692-4730

Phone(815) 988-8500

Sole ProprietorNo

Enumeration DateMarch 3, 2016

Last NPPES UpdateApril 9, 20193 updates tracked since enumeration

✔ NPI 1902266992 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in IL · 209014174

Also ListedRegistered NurseTaxonomy 163W00000X · License 041398969 (IL)

2222 E STATE ST STE 209, Rockford, IL 61104

Open in Google Maps ↗

Secondary Practice Location 1

Location 15405 N Knoxville AvePeoria, IL 61614-5016 · Phone (309) 691-4410 · Fax (309) 692-4730

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Miranda Kennedy 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 61104 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

$85.71 typical visit price

range $54.80 – $168.44

Typical copayment $21.42 (range $13.70 – $42.11)

Most-billed visit code 99203

Established Patient

$97.25 typical visit price

range $17.16 – $136.56

Typical copayment $24.31 (range $4.29 – $34.14)

Most-billed visit code 99214

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 20

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

NICOLE GONZALEZ

Nurse Practitioner (Family)