KEVIN P SCULLY (NPI# 1730199563) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1730199563 |
| Entity Type | Individual |
| Full Name | KEVIN P SCULLY |
| Credential | PAC |
| Practice Address |
6210 S Broadway Ave Tyler TX 75703-4413 |
| Mailing Address |
Po Box 99371 Fort Worth TX 76199-0371 |
| Practice Telephone | 9035792718 |
| Practice Fax Number | 9035792793 |
| Mailing Telephone | 6828851855 |
| Mailing Fax Number | 6828857347 |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2018-08-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA03374 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 192484701 | 05 | |
| TX | 192484704 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 837 S Fleishel Ave, Tyler, TX 757012017 | 9035260450 | 9035260435 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770978363 | Kevin James Scully | Student in an Organized Health Care Education/Training Program | 22 Bramhall St, Portland, ME 04102-3134 | 2015-04-01 |
| 1083655708 | Kevin T Scully | Internal Medicine | 1720 Nicholasville Rd, Suite 601, Lexington, KY 40503-1475 | 2006-06-10 |
| 1114983772 | Kevin S Scully | Orthopaedic Surgery | 2716 Ashton Dr, Wilmington, NC 28412-2489 | 2006-04-24 |
| Street Address |
6210 S BROADWAY AVE |
| City | TYLER |
| State | TX |
| Zip Code | 75703-4413 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326082892 | East Texas Medical Center Healthcare Associates | Emergency Medicine | 6210 S Broadway Ave, Tyler, TX 75703-4413 | 2006-06-15 |
| 1699101832 | Amanda S Jenkins | Nurse Practitioner | 6210 S Broadway Ave, Tyler, TX 75703-4413 | 2013-09-19 |
| 1861426041 | Smith Emergency Medicine Associates Pa | Physician Assistant | 6210 S Broadway Ave, Tyler, TX 75703-4413 | 2006-07-11 |
| 1235167586 | Lauren Lynn Hornell | Family Medicine | 6210 S Broadway Ave, Tyler, TX 75703-4413 | 2006-06-28 |
| 1083641559 | Douglas Frederick Johnston | Family Medicine | 6210 S Broadway Ave, Tyler, TX 75703-4413 | 2006-06-28 |
| 1215972591 | Bryan Todd Hyland | Family Medicine | 6210 S Broadway Ave, Tyler, TX 75703-4413 | 2006-06-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174155477 | Choice Supportive Care Team Inc. | Family Medicine | 4293 Kinsey Drive, Tyler, TX 75703 | 2020-02-05 |
| 1770052532 | Refinery Chiropractic LLC | Chiropractor | 16637 Old Jacksonville Hwy, Suite D, Tyler, TX 75703 | 2018-11-21 |
| 1215419353 | Deidre Lynn Fergason | Occupational Therapy Assistant | 3505 Old Jacksonville Hwy, Tyler, TX 75703 | 2018-09-05 |
| 1710473681 | Justin Taylor Ross | Dentist | 8938 S Broadway Ave Ste 380, Tyler, TX 75703 | 2018-07-03 |
| 1457843450 | Adam Tyler Barnes, Dds of Texas II, Pllc | Dentist | 8938 South Broadway, Ste 480, Tyler, TX 75703 | 2018-06-05 |
| 1083106462 | Integrity Health | Internal Medicine | 5605 Old Bullard Rd Ste B, Tyler, TX 75703 | 2018-06-01 |
| 1427572544 | Cody Wayne Graham | Pharmacist | 5415 S. Broadway Ave., Tyler, TX 75703 | 2017-07-31 |
| 1750805941 | Roger Bryan Chapman | Nurse Practitioner | 6115 New Copeland Rd, Tyler, TX 75703 | 2017-07-28 |
| 1427570084 | Darah Lynne Dahlem | Speech-Language Pathologist | 401 E. Front Street Ste 123, Tyler, TX 75703 | 2017-07-14 |
| 1194267468 | Herman Lester Hampton Jr. | Surgery | 5803 Regents Row, Tyler, TX 75703 | 2016-11-17 |
| Find all providers in zip 75703 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972129997 | Elizabeth Niedrauer | Physician Assistant | 2314 S Kennedy Ave, Tyler, TX 75701-5242 | 2020-06-25 |
| 1629489042 | Lifetime Health Center | Physician Assistant | 1420 Wsw Loop 323, Suite 100, Tyler, TX 75701-9347 | 2014-05-20 |
| 1407273428 | East Texas Physician Assistant Services | Physician Assistant | 5380 Old Bullard Rd Ste 600-125, Tyler, TX 75703-3607 | 2014-03-27 |
| 1023356524 | Vitality Center | Physician Assistant | 14444 Eastside Rd, Tyler, TX 75707-6724 | 2013-01-18 |
| 1790029007 | John M Mclean | Physician Assistant | 3700 Mcdonald Rd, Apt 260, Tyler, TX 75701-6253 | 2012-11-27 |
| 1124058524 | David Beck | Physician Assistant | 1133 Medical Dr, Tyler, TX 75701-2130 | 2006-07-03 |
| 1467444141 | Thomas R Scholler | Physician Assistant | 703 S Fleishel Ave, Tyler, TX 75701-2015 | 2005-08-18 |
| 1376535054 | Stephanie S Carter | Physician Assistant | 703 S Fleishel Ave Ste 4000, Tyler, TX 75701 | 2005-08-18 |
| 1992797799 | Matthew M Hand | Physician Assistant | 619 S Fleishel Ave, Suite 101, Tyler, TX 75701-2004 | 2005-08-17 |
| 1518962299 | Nina Beth Partin | Physician Assistant | 910 E Houston St, Ste 550, Tyler, TX 75702-8369 | 2005-06-17 |
| Find all providers in TYLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.