Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Dr. Ethan Owen Kennedy, DO

Individual provider Family Medicine Physician · NPI 1972679181

Dr. Ethan Owen Kennedy, DO is a Family Practice in Phoenix, Arizona. Graduated from Kansas City University of Med & Biosciences, College of Osteo Med in 1995, 31 years ago. Practices with Healthy Life Corporation, an 11-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Arizona.

Years since qualifying
31
Trained at
Kansas City University of Med & Biosciences, College of Osteo Med
Licensed in
AZ
In the registry since
2006
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

10240 W Indian School Rd Ste 155
Phoenix, AZ 85037-5909
Phone: (623) 385-7900
Fax: (623) 440-4360
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 8260 W Indian School Rd Ste 4, Phoenix, AZ 85033-2980 — (623) 247-2300

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 3123 (AZ)

Record details

NPI number1972679181
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedNovember 28, 2006
Last updated in NPPESDecember 20, 2023
Certification dateDecember 20, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolKANSAS CITY UNIVERSITY OF MED & BIOSCIENCES, COLLEGE OF OSTEO MED
Graduated 1995 (31 years in practice)
Group practice Healthy Life Corporation — 11 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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