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CRISWELL ALLEN KENNEDY M.D.
NPI 1912122847
General Practice in Liberty Lake, WA

Active since April 16, 2007PECOS Enrolled
24128 E ALKI LN, LIBERTY LAKE, WA 99019(509) 255-5065(509) 477-6352 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: October 04, 2026.

About Criswell Allen Kennedy M.d. NPPES

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

CRISWELL ALLEN KENNEDY M.D. (NPI 1912122847) is an individual general practice provider in Liberty Lake, Washington, licensed in Washington (MD00017804) and active in the NPI registry since April 2007. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1912122847
Entity TypeIndividualMale
Primary Taxonomy208D00000X
Provider Legal NameCRISWELL ALLEN KENNEDYCredential: M.D.
Location Address24128 E ALKI LNLiberty Lake, WA 99019-9447
Mailing Address24128 E Alki LnLiberty Lake, WA 99019-9447 · (509) 255-5065 · Fax (509) 477-6352
Phone(509) 255-5065
Fax(509) 477-6352
Sole ProprietorYes
Enumeration DateApril 16, 2007
Last NPPES UpdateJuly 8, 2007
✔ NPI 1912122847 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in WA · MD00017804
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
24128 E ALKI LN, Liberty Lake, WA 99019
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Criswell Allen Kennedy M.d. 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.

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 Criswell Kennedy's NPI number?

The NPI number for Criswell Kennedy is 1912122847. It was assigned to this individual provider in the NPPES registry on April 16, 2007.

Where is Criswell Kennedy located?

Criswell Kennedy practices at 24128 E Alki Ln, Liberty Lake, WA 99019. The listed phone number is (509) 255-5065.

What is Criswell Kennedy's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Criswell Kennedy enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Criswell Kennedy was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.