Active NPI
Kyle Mitchell Koelker, PA-C
- Physician Assistant
- Sunnyvale, TX
National Provider Identifier
1619535366
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA12753
- Practice address
- 222 S Collins Rd Ste 101
Sunnyvale, TX 75182-4645 - Phone
- (512) 519-1254
- NPI assigned
- May 29, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA12753 | TX | Primary |
Addresses
Primary practice location
222 S Collins Rd Ste 101
Sunnyvale, TX 75182-4645
Mailing address
1860 Crestland Dr
Lucas, TX 75002-8566
Phone (972) 835-9582
Other practice location 1
206 S Clay St
Ennis, TX 75119-4527
Phone (214) 256-3778 ext. 63778
Other practice location 2
874 Ed Hall Dr Ste 104
Kaufman, TX 75142-1800
Phone (214) 256-3778
Medicare participation
Medicare enrollment files- 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: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Organizations & group practices 1
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.
-
- Orthopaedic Surgery Physician
- Sunnyvale, TX
- NPI 1346569829
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1559088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782345600000",
"number": "1619535366",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1860 CRESTLAND DR",
"city": "LUCAS",
"state": "TX",
"postal_code": "750028566",
"telephone_number": "972-835-9582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 S COLLINS RD STE 101",
"city": "SUNNYVALE",
"state": "TX",
"postal_code": "751824645",
"telephone_number": "512-519-1254"
}
],
"practiceLocations": [
{
"address_1": "206 S Clay St",
"address_purpose": "LOCATION",
"city": "Ennis",
"state": "TX",
"postal_code": "751194527",
"country_code": "US",
"telephone_number": "214-256-3778 x63778",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "874 Ed Hall Dr Ste 104",
"address_purpose": "LOCATION",
"city": "Kaufman",
"state": "TX",
"postal_code": "751421800",
"country_code": "US",
"telephone_number": "214-256-3778",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KOELKER",
"first_name": "KYLE",
"middle_name": "MITCHELL",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-05-29",
"last_updated": "2026-06-25",
"certification_date": "2026-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "TX",
"license": "PA12753",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sunnyvale, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2026; 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.