Cecil J Fackrell, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

15-01306 Issued in KS

Practice address

6333 Long Ave
Suite 360
Shawnee, KS 66216-2500

Phone

(913) 631-6330

Fax

(913) 631-6222

NPI assigned

Apr 10, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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

• American Dermatology Associates, LLC

  • Dermatology Physician
  • Shawnee Mission, KS
  • NPI 1063441103
  NPD (past)
• Ryan D Wells MD PC

  • Dermatology Physician
  • Camarillo, CA
  • NPI 1588922561
  NPD (past)

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489536000000",
    "number": "1174646400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6333 LONG AVE",
            "address_2": "SUITE 360",
            "city": "SHAWNEE",
            "state": "KS",
            "postal_code": "662162500",
            "telephone_number": "913-631-6330",
            "fax_number": "913-631-6222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6333 LONG AVE",
            "address_2": "SUITE 360",
            "city": "SHAWNEE",
            "state": "KS",
            "postal_code": "662162500",
            "telephone_number": "913-631-6330",
            "fax_number": "913-631-6222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FACKRELL",
        "first_name": "CECIL",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-10",
        "last_updated": "2017-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-01306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Exodus Health, L.L.C.
• Eye Associates of Shawnee PA
• Eye-Pros of Shawnee Inc
• Tory Eylar, CFA
• Betsy Ezell
• Susan K Fajardo, R.P.A.C.
• Diana Faltermeier, APRN
• Ann Adams Fay, DDS
• Anne Feye
• Kara Renee Field, APRN

• Physician Assistant in Shawnee, KS
• Providers in Shawnee, KS by specialty
• Physician Assistant in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.