Active NPI
Kenneth Lee Underwood, PA-C
- Physician Assistant
- Bullhead City, AZ
National Provider Identifier
1629017900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1934
- Practice address
- 3015 Highway 95
Suite 105
Bullhead City, AZ 86442-4334 - Phone
- (928) 763-2001
- Fax
- (928) 763-2038
- NPI assigned
- Jun 5, 2006
- 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 | 1934 | AZ | Primary |
Addresses
Primary practice location
3015 Highway 95
Suite 105
Bullhead City, AZ 86442-4334
Mailing address
PO Box 20828
Bullhead City, AZ 86439-0828
Phone (928) 763-2001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency Physicians Professional Association LTD | Past | Accepting new patients |
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.
-
- Emergency Medicine Physician
- Phoenix, AZ
- NPI 1114931490
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1629017900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 20828",
"city": "BULLHEAD CITY",
"state": "AZ",
"postal_code": "864390828",
"telephone_number": "928-763-2001",
"fax_number": "928-763-2038"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3015 HIGHWAY 95",
"address_2": "SUITE 105",
"city": "BULLHEAD CITY",
"state": "AZ",
"postal_code": "864424334",
"telephone_number": "928-763-2001",
"fax_number": "928-763-2038"
}
],
"practiceLocations": [],
"basic": {
"last_name": "UNDERWOOD",
"first_name": "KENNETH",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-05",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "AZ",
"license": "1934",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bullhead City, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.