KCN Novak LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

15960 Issued in TX

Legal business name

KCN NOVAK LLC

Practice address

709 Hollybrook Dr
Ste 101
Longview, TX 75605-2411

Phone

(903) 234-8326

Fax

(903) 758-3808

NPI assigned

Aug 18, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Don Novak, RPH

Title

Owner

Phone

(903) 234-8326

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• MEDICAL PARK PHARMACY Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Denise Harper, RPH

  • Pharmacist
  • Longview, TX
  • NPI 1578036885
  NPD
• Donald Novak, RPH

  • Pharmacist
  • Longview, TX
  • NPI 1225501513
  NPD

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758240000000",
    "number": "1497869481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 N 3RD ST",
            "address_2": "SUITE # 1",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756016550",
            "telephone_number": "903-234-8329",
            "fax_number": "903-247-9513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 HOLLYBROOK DR",
            "address_2": "STE 101",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756052411",
            "telephone_number": "903-234-8326",
            "fax_number": "903-758-3808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KCN NOVAK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2025-09-19",
        "status": "A",
        "authorized_official_last_name": "NOVAK",
        "authorized_official_first_name": "DON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-234-8326",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "15960",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "144123",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2104156",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEDICAL PARK PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mindie Michelle Kavanaugh, MD
• Siima Nalwanga Kavuma, MD
• Dana Kay, OT
• Kaye B Ratzlaff, LPC, PLLC
• KC Medical Supplies
• Jerry Keaton, M.D.
• Samwel Kebaya
• Leslie A Keehne, D.C.
• Janet L. Kelley, MD
• Suzanne Kelley, LCDC

• Community/Retail Pharmacy in Longview, TX
• Providers in Longview, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.