Active NPI
Eugene Kinnaly, P.A.
- Medical Physician Assistant
- St Augustine, FL
National Provider Identifier
1457323834
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA2353
- Practice address
- 100 Arricola Ave
St Augustine, FL 32080-4515 - Phone
- (904) 825-4701
- NPI assigned
- Feb 1, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA2353 | FL | Primary |
Addresses
Primary practice location
100 Arricola Ave
St Augustine, FL 32080-4515
Mailing address
3114 Haley Pointe Rd
St Augustine, FL 32084-3081
Phone (904) 824-7794
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA2353 | FL | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1256342400000",
"number": "1457323834",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3114 HALEY POINTE RD",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320843081",
"telephone_number": "904-824-7794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 ARRICOLA AVE",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320804515",
"telephone_number": "904-825-4701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KINNALY",
"first_name": "EUGENE",
"name_prefix": "Mr.",
"credential": "P.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-01",
"last_updated": "2009-10-24",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "FL",
"license": "PA2353",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2009; 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.