Kendall Polk, CSFA

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

SA00635 Issued in TX

Practice address

205 Crenshaw Dr
Mansfield, TX 76063-3451

Phone

(214) 927-6539

Fax

(817) 394-1231

NPI assigned

Dec 8, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Quality Assist, LLC

  • Surgical Assistant
  • Mansfield, TX
  • NPI 1225495708
  NPD (past) Authorized official

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

{
    "created_epoch": "1449532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529107200000",
    "number": "1285009803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 E. BRAOD ST. STE 102#237",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760639157",
            "telephone_number": "214-927-6539",
            "fax_number": "817-394-1231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 CRENSHAW DR",
            "city": "MANSFIELD",
            "state": "TX",
            "postal_code": "760633451",
            "telephone_number": "214-927-6539",
            "fax_number": "817-394-1231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POLK",
        "first_name": "KENDALL",
        "credential": "CSFA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-12-08",
        "last_updated": "2018-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZS0410X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Technologist",
            "state": "TX",
            "license": "SA00635",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TX",
            "license": "SA00635",
            "primary": false
        },
        {
            "code": "246ZX2200X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Orthopedic Assistant",
            "state": "TX",
            "license": "SA00635",
            "primary": false
        },
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "TX",
            "license": "SA00635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1225495708",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Nick Podgurecki, M.D.
• Traci Poe, MA, MCCLC
• Point of Change Counseling Education and Training Services
• Poised Potential Counseling and Consulting PLLC
• Kanisha Polk
• Jill Ann Pollard, LCSW
• Michael Clark Polson, D.C.
• Emanuel Ponce
• Magdala Poon, M.D.
• Iman Popal

• Surgical Assistant in Mansfield, TX
• Providers in Mansfield, TX by specialty
• Surgical Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.