Individual provider Active NPI

Kyle McKenna, DO

  • Student in an Organized Health Care Education/Training Program
  • Little Rock, AR
National Provider Identifier
1609627389
Registry record updated Mar 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
4301 W Markham St # 589
Little Rock, AR 72205-7101
Phone
(501) 526-8148
NPI assigned
Mar 29, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

4301 W Markham St # 589
Little Rock, AR 72205-7101

Mailing address

19428 Devonwood Cir
Fort Myers, FL 33967-4853

Other practice location 1

1 Childrens Way # 512-41
Little Rock, AR 72202-3500
Phone (501) 364-1836

Other practice location 2

1125 N College Ave # Slot100
Fayetteville, AR 72703-1908
Phone (479) 713-8310

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
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

NPI Registry JSON

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

{
    "created_epoch": "1711670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711670400000",
    "number": "1609627389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19428 DEVONWOOD CIR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339674853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4301 W MARKHAM ST # 589",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722057101",
            "telephone_number": "501-526-8148"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Childrens Way # 512-41",
            "address_purpose": "LOCATION",
            "city": "Little Rock",
            "state": "AR",
            "postal_code": "722023500",
            "country_code": "US",
            "telephone_number": "501-364-1836",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1125 N College Ave # Slot100",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "AR",
            "postal_code": "727031908",
            "country_code": "US",
            "telephone_number": "479-713-8310",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKENNA",
        "first_name": "KYLE",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-03-29",
        "last_updated": "2024-03-29",
        "certification_date": "2024-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Little Rock, AR

Sources for this page

Verify at the official NPI Registry.