Kelly S Coyne, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA52493 Issued in CA

Practice address

4791 E Palm Canyon Dr
Suite 200
Palm Springs, CA 92264-5220

Phone

(760) 834-7950

NPI assigned

Aug 14, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

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.

• Eisenhower Medical Center

  • General Acute Care Hospital
  • Rancho Mirage, CA
  • NPI 1013981554
  NPD (past)

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

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459814400000",
    "number": "1235142977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4791 E PALM CANYON DR",
            "address_2": "SUITE 200",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "922645220",
            "telephone_number": "760-834-7950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4791 E PALM CANYON DR",
            "address_2": "SUITE 200",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "922645220",
            "telephone_number": "760-834-7950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COYNE",
        "first_name": "KELLY",
        "middle_name": "S",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-14",
        "last_updated": "2016-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA52493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PA52493",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• County of Riverside- Community Health Agency
• County of Riverside-Community Health Agency
• County of Riverside-Community Health Agency
• Coleman Scott Cowart
• Cox Dental Corporation
• Patricia Diane Craine, MA LMFT
• Bruce S Crawford, D.C.
• Kevin Crawford Jr.
• Michelle Alice Creed
• Sean Thomas Creegan, DO

• Physician Assistant in Palm Springs, CA
• Providers in Palm Springs, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2016; 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.