Kurt W Kenoyer, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA10004740 Issued in WA

Practice address

6926 NE Fourth Plain Blvd
Vancouver, WA 98661-7254

Phone

(360) 993-3000

NPI assigned

Jun 18, 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 6

Medicare fee-for-service enrollment

Enrolled in WA, TX2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Columbia River Mental Health Services

  dba Columbia River Associates

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Vancouver, WA
  • NPI 1669411377
  Medicare reassignment
• Muckleshoot Indian Tribe

  dba Muckleshoot Health and Wellness Center

  • Clinic/Center
  • Auburn, WA
  • NPI 1558448175

  TX

  Medicare reassignment
• Star Medical Clinic Inc.

  • Clinic/Center
  • Centralia, WA
  • NPI 1790037224
  NPD (past)

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1396780979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6926 NE FOURTH PLAIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986617254",
            "telephone_number": "360-993-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6926 NE FOURTH PLAIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986617254",
            "telephone_number": "360-993-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENOYER",
        "first_name": "KURT",
        "middle_name": "W",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2023-03-07",
        "certification_date": "2022-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10004740",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUESHIELD INS",
            "identifier": "2159KE",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUESHIELD INS",
            "identifier": "9974KE",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1009425",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUESHIELD INS",
            "identifier": "9749KE",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUESHIELD INS",
            "identifier": "1599KE",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8415440",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tara Lynn Kennedy, MA
• Kenneth a Shultz Edd PS
• Kenneth Killpack, DDS, P.C. (Affordable Dentures & Implants - Vancouver)
• Sheryl Elizabeth Kennon, B.S.
• John Stephen Kenny, DDS
• Ashrielle Kent
• Carrie M Kent, DO
• Kara Kent, BA
• Victoria G Kenyon, RN
• Paul Manchester Keown, MD

• Physician Assistant in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.