NPIMap

Individual provider Active NPI

Kendell Dwayne Varner, PHYSICIAN ASSISTANT

  • Physician Assistant
  • Clay Center, KS
National Provider Identifier
1205305307
Registry record updated Feb 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-859 Issued in AR
Practice address
617 Liberty St
Clay Center, KS 67432-1564
Phone
(785) 632-2144
NPI assigned
Nov 19, 2018
Last updated
Feb 6, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 15-02169 KS
Physician Assistant 363A00000X PA-859 AR Primary

Addresses

Primary practice location

617 Liberty St
Clay Center, KS 67432-1564

Mailing address

1753 10TH Rd
Clay Center, KS 67432-7241
Phone (479) 936-1700

Other practice location 1

5501 W Pinnacle Pointe Dr
Rogers, AR 72758-8131
Phone (479) 268-6404

Other identifiers 1

IdentifierTypeStateIssuer
1158140OtherNCCPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS, AR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20181221002103 KS Practitioner - Physician Assistant 1153666995 Reassigns benefits to 4 organizations
I20240918004397 AR Practitioner - Physician Assistant 1153666995 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Rooks County Health Center CurrentSince Jun 8, 2024 Accepting new patients
Rooks County Health Center CurrentSince Jun 8, 2024 Accepting new patients
Clay County Medical Center Nurse Practitioner Current Accepting new patients
Rooks County Health Center CurrentSince Jul 8, 2024 Accepting new patients
Phillips County Hospital Physician Assistant CurrentSince Dec 21, 2024 Accepting new patients
Clay County Medical Center CurrentSince Dec 1, 2018 Accepting new patients
Phillips County Hospital CurrentSince Dec 21, 2024 Accepting new patients
Clay County Medical Center CurrentSince Dec 1, 2018 Accepting new patients
Rooks County Health Center Current Accepting new patients
New Directions Physician Weight Loss Past Accepting new patients
Grisell Memorial Hospital District 1 Past Accepting new patients

Locations

609 Liberty St
Clay Center, KS 67432
Phone (785) 632-2181

617 Liberty St
Clay Center, KS 67432
Phone (785) 632-2144

1150 State St
Phillipsburg, KS 67661
Phone (785) 543-5226

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/7618/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir-myrecord.cerner.com/r4/88f6f0ad-680b-460f-ba7c-9dd496dece04/

Organizations & group practices 12

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": "1542585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675641600000",
    "number": "1205305307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1753 10TH RD",
            "city": "CLAY CENTER",
            "state": "KS",
            "postal_code": "674327241",
            "telephone_number": "479-936-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "617 LIBERTY ST",
            "city": "CLAY CENTER",
            "state": "KS",
            "postal_code": "674321564",
            "telephone_number": "785-632-2144"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5501 W Pinnacle Pointe Dr",
            "address_purpose": "LOCATION",
            "city": "Rogers",
            "state": "AR",
            "postal_code": "727588131",
            "country_code": "US",
            "telephone_number": "479-268-6404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VARNER",
        "first_name": "KENDELL",
        "middle_name": "DWAYNE",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-19",
        "last_updated": "2023-02-06",
        "certification_date": "2023-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KS",
            "license": "15-02169",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "PA-859",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCCPA",
            "identifier": "1158140",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clay Center, KS

Sources for this page

Verify at the official NPI Registry.