CMS-1500 Box 24J / 33a • NPI
1780311316
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
235Z00000X (CMS 15)
Licensed & Credentialed Speech, Language and Hearing Service Providers
Box 32 Service Location & ZIP+4
1710 MOORES LN, TEXARKANA, TX, 75503-1858
✓ 9-Digit EDI 837 ZIP+4 (75503-1858)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1780311316 (KENNEDY BREA FAULKENBERRY) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1780311316 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | KENNEDY BREA FAULKENBERRY |
| Plain-English Specialty | Licensed & Credentialed Speech, Language and Hearing Service Providers NUCC Code: 235Z00000X (Speech-Language Pathologist, ) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 1710 MOORES LN, TEXARKANA, TX, 75503-1858 |
| Practice Telephone / Fax | Tel: (903) 794-2705 |
| Administrative Mailing Address | 154 YARBOROUGH AVE, ASHDOWN, AR, 71822-8446 |
| Enumeration & Last Sync | Enumerated: 2022-08-03 | CMS Record Updated: 2023-09-27 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (235Z00000X)
What Does Taxonomy Code 235Z00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 235Z00000X translates to:
"Licensed & Credentialed Speech, Language and Hearing Service Providers"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (KENNEDY BREA FAULKENBERRY)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
235Z00000X — Speech-Language Pathologist, Plain English: Licensed & Credentialed Speech, Language and Hearing Service Providers | State: N/A | License: Verified | Primary: Secondary |
235Z00000X — Speech-Language Pathologist, Plain English: Licensed & Credentialed Speech, Language and Hearing Service Providers | State: AR | License: 201971 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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