NPIMap

Individual provider Active NPI

Kyle Houston Hackney, DDS

  • Dentist
  • Shelton, WA
National Provider Identifier
1265686463
Registry record updated Nov 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DE 60035243 Issued in WA
Practice address
1051 SE State Route 3
Shelton, WA 98584-7117
Phone
(360) 426-1676
Fax
(360) 427-4303
NPI assigned
Nov 14, 2008
Last updated
Nov 14, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DE 60035243 WA Primary

Addresses

Primary practice location

1051 SE State Route 3
Shelton, WA 98584-7117

Mailing address

1051 SE State Route 3
Shelton, WA 98584-7117
Phone (360) 426-1676

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DE 60035243WAMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Hackney Family Dentistry Past Accepting new patients

Organizations & group practices 1

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": "1226620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1226620800000",
    "number": "1265686463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1051 SE STATE ROUTE 3",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985847117",
            "telephone_number": "360-426-1676",
            "fax_number": "360-427-4303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 SE STATE ROUTE 3",
            "city": "SHELTON",
            "state": "WA",
            "postal_code": "985847117",
            "telephone_number": "360-426-1676",
            "fax_number": "360-427-4303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKNEY",
        "first_name": "KYLE",
        "middle_name": "HOUSTON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-14",
        "last_updated": "2008-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE 60035243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelton, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2008; 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.