Individual provider Active NPI

Kayla F Emerick

  • Physician Assistant
  • Bentonville, AR
National Provider Identifier
1306579503
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-1372 Issued in AR
Practice address
1720 S Walton Blvd Ste 6
Bentonville, AR 72712-7533
Phone
(479) 464-0834
Fax
(479) 464-0836
NPI assigned
Jul 5, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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
Physician Assistant 363A00000X PA-1372 AR Primary

Addresses

Primary practice location

1720 S Walton Blvd Ste 6
Bentonville, AR 72712-7533

Mailing address

1720 S Walton Blvd Ste 6
Bentonville, AR 72712-7533
Phone (479) 464-0834

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
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

Enrollment IDStateProvider typePAC IDDetails
I20250520001762 AR Practitioner - Physician Assistant 7719405075 Reassigns benefits to 1 organization

National Provider Directory

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

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1656979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753660800000",
    "number": "1306579503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 S WALTON BLVD STE 6",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727127533",
            "telephone_number": "479-464-0834",
            "fax_number": "479-464-0836"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 S WALTON BLVD STE 6",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727127533",
            "telephone_number": "479-464-0834",
            "fax_number": "479-464-0836"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EMERICK",
        "first_name": "KAYLA",
        "middle_name": "F",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-05",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "PA-1372",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bentonville, AR

Sources for this page

Verify at the official NPI Registry.