Individual provider Active NPI

Kendall Lauren Key, PA-C

  • Physician Assistant
  • Fayetteville, AR
National Provider Identifier
1578835534
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA-462 Issued in AR
Practice address
1695 E. Rainforest Rd.
Suite 2
Fayetteville, AR 72703
Phone
(479) 445-6460
Fax
(479) 254-9652
NPI assigned
Feb 6, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA-462 AR Primary

Addresses

Primary practice location

1695 E. Rainforest Rd.
Suite 2
Fayetteville, AR 72703

Mailing address

1695 E. Rainforest Rd.
Suite 2
Fayetteville, AR 72703
Phone (479) 445-6460

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
I20120510000284 AR Practitioner - Physician Assistant 1658533500 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA-462ARMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Roller Weight Loss Institute Inc CurrentSince Dec 11, 2021 Accepting new patients

Locations

1695 E Rainforest Rd
Ste 2
Fayetteville, AR 72703
Phone (479) 445-6460

1695 E Rainforest Rd
Fayetteville, AR 72703
Phone (479) 445-6460

Organizations & group practices 3

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": "1328486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1578835534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1695 E. RAINFOREST RD.",
            "address_2": "SUITE 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72703",
            "telephone_number": "479-445-6460",
            "fax_number": "479-254-9652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1695 E. RAINFOREST RD.",
            "address_2": "SUITE 2",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "72703",
            "telephone_number": "479-445-6460",
            "fax_number": "479-254-9652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEY",
        "first_name": "KENDALL",
        "middle_name": "LAUREN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-06",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "PA-462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

Sources for this page

Verify at the official NPI Registry.