Archie M Kinney, PA C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

1148 Issued in AZ

Practice address

200 West Hospital Drive
Whiteriver, AZ 85941-0860

Phone

(928) 338-4911

Fax

(928) 338-1122

NPI assigned

Oct 24, 2005

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 4

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

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

• DHHS IHS Phoenix Area

  dba Whiteriver Indian Hospital

  • General Acute Care Hospital
  • Whiteriver, AZ
  • NPI 1427335140

  TX

  Medicare reassignment NPD
• DHHS IHS Phoenix Area

  dba Cibecue IHS Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Cibecue, AZ
  • NPI 1467587030
  NPD (past)

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363651200000",
    "number": "1295725067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860",
            "address_2": "WHITERIVER INDIAN HOSPITAL",
            "city": "WHITERIVER",
            "state": "AZ",
            "postal_code": "859410860",
            "telephone_number": "928-338-4911",
            "fax_number": "928-338-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 WEST HOSPITAL DRIVE",
            "city": "WHITERIVER",
            "state": "AZ",
            "postal_code": "859410860",
            "telephone_number": "928-338-4911",
            "fax_number": "928-338-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINNEY",
        "first_name": "ARCHIE",
        "middle_name": "M",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-24",
        "last_updated": "2013-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "1148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "698821",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1427335140",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1427335181",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "970030184",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dakota Kay, PT
• Dianna Jean Kelley, RN BSN
• Audrey J Kessay, R.N.
• Ayesha Khalil, RD
• Ji Young Kim
• Anna Un-Un Kit, PHARM.D.
• Chelsea J. Kleinmeyer, R.N.
• Mark Wesley Kleve, M.D.
• Heidi A Knepper, LMSW
• Crystal Lynn La Rose, CNM

• Physician Assistant in Whiteriver, AZ
• Providers in Whiteriver, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.