Kenneth Alan Wade, P.A

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

1015921206 Issued in UT

Practice address

1325 N 600 E
Suite 102
Logan, UT 84341-6738

Phone

(435) 753-9999

Fax

(435) 753-2301

NPI assigned

Jan 12, 2007

Sex

Male

Sole proprietor

No

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

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cache Valley Womens Center, PLLC

  • Obstetrics & Gynecology Physician
  • Logan, UT
  • NPI 1922217850
  NPD (past)

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

{
    "created_epoch": "1168560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480377600000",
    "number": "1699826149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 N 600 E",
            "address_2": "SUITE 102",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843416738",
            "telephone_number": "435-753-9999",
            "fax_number": "435-753-2301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 N 600 E",
            "address_2": "SUITE 102",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843416738",
            "telephone_number": "435-753-9999",
            "fax_number": "435-753-2301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "KENNETH",
        "middle_name": "ALAN",
        "name_prefix": "Mr.",
        "credential": "P.A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-12",
        "last_updated": "2016-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "UT",
            "license": "1015921206",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "1015921206",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• W Bryce Cook DPM Inc (Foot Clinic of Logan)
• W Reed Jaussi MD PC
• Sheila Romney Waddoups, PT
• Denice Stratford Wade
• Kassie Love Wade, MSW
• Daniel Jacob Wagner, BCBA
• Wal-Mart Stores, Inc. (Vision Center 30-1888)
• Wal-Mart Stores, Inc. (Walmart Vision Cneter 30-4272)
• Walgreen Co (Walgreens #10552)
• Ada R Walker

• Medical Physician Assistant in Logan, UT
• Providers in Logan, UT by specialty
• Medical Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; 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.