McKenzie Kyle Verbout, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D14575 Issued in MN

Practice address

2219 Paul Bunyan Dr NW Ste 6-7
Bemidji, MN 56601-6188

Phone

(218) 751-2659

NPI assigned

Apr 4, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• McKenzie Kyle Timms Former name

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Department of Health & Human Services PHS IHS

  • Critical Access Hospital
  • Cass Lake, MN
  • NPI 1194754382

  TX

  Medicare reassignment NPD

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

{
    "created_epoch": "1617494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622764800000",
    "number": "1609455039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10783 SPRING DR NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566012009",
            "telephone_number": "218-308-3833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2219 PAUL BUNYAN DR NW STE 6-7",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566016188",
            "telephone_number": "218-751-2659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VERBOUT",
        "first_name": "MCKENZIE",
        "middle_name": "KYLE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-04",
        "last_updated": "2021-06-04",
        "certification_date": "2021-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MCKENZIE",
            "last_name": "TIMMS",
            "middle_name": "KYLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Stephen J Vandyke, OD
• David A Vanengelenhoven, M.D.
• Charly Candas Vangrinsven, B.S.,LADC
• Tempest Varner, MD
• Elice Leanne Varney
• Gwen Marie Verchota, FNP
• Marina Jennifer Verke, RN
• Vicki Lynn Roff
• Hannah Moussa Vines, MD
• Vision Optical Inc

• General Practice Dentistry in Bemidji, MN
• Providers in Bemidji, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2021; 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.