Kevin P Scully, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA03374 Issued in TX

Practice address

2210 Three Lakes Pkwy Ste 100
Tyler, TX 75703-0642

Phone

(903) 747-4050

Fax

(903) 747-4075

NPI assigned

Aug 8, 2006

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

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Etmc Physician Group, Inc.Group PAC ID 4486915600, 375 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Etmc Physician Group Inc.

  • Cardiovascular Disease Physician
  • Tyler, TX
  • NPI 1609382662
  Medicare reassignment Care Compare group
• Integrity Health

  • Physician Assistant
  • Tyler, TX
  • NPI 1083106462
  NPD (past) Authorized official
• Ellis Emergency Physicians PLLC

  • Emergency Medicine Physician
  • Waxahachie, TX
  • NPI 1902856107
  NPD (past)

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770249600000",
    "number": "1730199563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2210 THREE LAKES PKWY STE 100",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757030642",
            "telephone_number": "903-747-4050",
            "fax_number": "903-747-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2210 THREE LAKES PKWY STE 100",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757030642",
            "telephone_number": "903-747-4050",
            "fax_number": "903-747-4075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCULLY",
        "first_name": "KEVIN",
        "middle_name": "P",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2026-02-05",
        "certification_date": "2026-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA03374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John William Scroggins Jr., M.D.
• Kimberly Scroggins
• Kristen Nicole Scroggins, PA
• Kerry Scruggs, ANP
• Laura Scudder
• Elizabeth Abigail Seabury, H.I.S.
• Glenda R Sealey, CRNA
• Betty Darlene Searcey
• Sears Tyler Methodist Retirement Corporation (Longleaf Meadows Healthcare Center)
• Stephanie Seawright, PHARM. D.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.