Kevin E. Mayberry, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

650 Joel Dr
Fort Campbell, KY 42223-5318

Phone

(270) 798-3969

NPI assigned

Sep 20, 2010

Last updated

Sep 1, 2026By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1284940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788220800000",
    "number": "1669780078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235318",
            "telephone_number": "270-798-3969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235318",
            "telephone_number": "270-798-3969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYBERRY",
        "first_name": "KEVIN",
        "middle_name": "E.",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-09-20",
        "last_updated": "2026-09-01",
        "certification_date": "2026-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNESSEE STATE LICENSE",
            "identifier": "PA0000003853",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Matsinger, PT, DPT
• Bradley Michael Matthews, PA
• Cameron Mattingly
• Brett Allen Matzek, M.D.
• Marion W Mault, LPCC
• Peggy Ann Mayfield
• Robb Maylor
• Nathan C Maynard, MS, LAT, ATC
• Harold E Mazurek, PA-C
• Shellon Angela McAllister-Rogers, MD

• Medical Physician Assistant in Fort Campbell, KY
• Providers in Fort Campbell, KY by specialty
• Medical Physician Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 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.

Verify at the official NPI Registry.