Tracy Leeann Keniston, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA10005307 Issued in WA

Practice address

111 S 11TH Ave Ste 320
Yakima, WA 98902-3273

Phone

(509) 454-8888

Fax

(509) 453-0061

NPI assigned

Oct 15, 2007

Sex

Female

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 2

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Yakima Valley Memorial PhysiciansGroup PAC ID 1557391596, 397 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Yakima Valley Memorial Hospital, Yakima, WA, CCN 500036

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tkeniston770254@direct.multicare.org

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.

• Yakima Valley Memorial Physicians

  • General Acute Care Hospital
  • Yakima, WA
  • NPI 1306933940
  Medicare reassignment Care Compare group
• Yakima Valley Memorial Physicians

  • Durable Medical Equipment & Medical Supplies
  • Yakima, WA
  • NPI 1366325870
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Yakima Valley Memorial Hospital Association

  • General Acute Care Hospital
  • Yakima, WA
  • NPI 1053373480
  Care Compare affiliation

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

{
    "created_epoch": "1192406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674691200000",
    "number": "1457549545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2309",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989072309",
            "telephone_number": "509-454-8888",
            "fax_number": "509-453-0061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 11TH AVE STE 320",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023273",
            "telephone_number": "509-454-8888",
            "fax_number": "509-453-0061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENISTON",
        "first_name": "TRACY",
        "middle_name": "LEEANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-15",
        "last_updated": "2023-01-26",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA10005307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA PA LICENSE",
            "identifier": "PA10005307",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1057024",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Megan M Kelly
• Michael Kelly
• Abra Pearl Kelson, MSW, LSWA-IC
• Julianne Johnette Kemp
• Kellee Keniston
• Barbara Kennedy, RN
• Jessica Lynn Kennedy, DDS
• Nicholas Iung Kennedy, MD
• Teresa Kennedy
• Thomas C Kennedy, M.D.

• Surgical Physician Assistant in Yakima, WA
• Providers in Yakima, WA by specialty
• Surgical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.