Kevin Michael Glynn, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA03002 Issued in TX

Practice address

1215 E Court St
Seguin, TX 78155-5129

Phone

(830) 379-2411

NPI assigned

Sep 2, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• East Texas Medical Center Healthcare Associates

  • Emergency Medicine Physician
  • Tyler, TX
  • NPI 1326082892
  NPD (past)

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

{
    "created_epoch": "1125619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238630400000",
    "number": "1699769851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 CIMMARRON CIR",
            "city": "SEGUIN",
            "state": "TX",
            "postal_code": "781559748",
            "telephone_number": "830-303-3998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 E COURT ST",
            "city": "SEGUIN",
            "state": "TX",
            "postal_code": "781555129",
            "telephone_number": "830-379-2411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLYNN",
        "first_name": "KEVIN",
        "middle_name": "MICHAEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-02",
        "last_updated": "2009-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA03002",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "PA 03002",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8N8611",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gifted Hearts Medical Supply LLC
• Jamie Gonzales-Malone, OTD, MOT
• Gabriel R Gonzales, DO
• Joselyne Gonzalez
• Kendel Gonzalez, NP
• Salli Marie Gonzalez

• Physician Assistant in Seguin, TX
• Providers in Seguin, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.