Individual provider Active NPI

Emma Kunkleman, DO

  • Pediatrics Physician
  • Myrtle Beach, SC
National Provider Identifier
1073298816
Registry record updated Oct 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
89928 Issued in SC
Practice address
8120 Rourk St
Myrtle Beach, SC 29572-4127
Phone
(843) 449-1438
Fax
(843) 286-1349
NPI assigned
Jun 20, 2023
Last updated
Oct 14, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 89928 SC Primary

Addresses

Primary practice location

8120 Rourk St
Myrtle Beach, SC 29572-4127

Mailing address

8120 Rourk St
Myrtle Beach, SC 29572-4127
Phone (843) 449-1438

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240104003276 SC Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 8729439641

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
LL89928SCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Strand Pediatrics & Adolescent Medicine, P.a. Past Accepting new patients
University Medical Associates of the Medical University of South Carol Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791936000000",
    "number": "1073298816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8120 ROURK ST",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724127",
            "telephone_number": "843-449-1438",
            "fax_number": "843-286-1349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8120 ROURK ST",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724127",
            "telephone_number": "843-449-1438",
            "fax_number": "843-286-1349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUNKLEMAN",
        "first_name": "EMMA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-20",
        "last_updated": "2026-10-14",
        "certification_date": "2026-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "89928",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.