Keith Edward Kyles

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT1604 Issued in AR

Practice address

430 Highway 56
Calico Rock, AR 72519-8852

Phone

(870) 701-5089

Fax

(870) 270-0896

NPI assigned

Oct 22, 2019

Last updated

Oct 22, 2019By 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 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1571702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571702400000",
    "number": "1801439989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2398",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726542398",
            "telephone_number": "870-701-5089",
            "fax_number": "870-277-0896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 HIGHWAY 56",
            "city": "CALICO ROCK",
            "state": "AR",
            "postal_code": "725198852",
            "telephone_number": "870-701-5089",
            "fax_number": "870-270-0896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KYLES",
        "first_name": "KEITH",
        "middle_name": "EDWARD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-22",
        "last_updated": "2019-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "PT1604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS STATE MEDICAL BOARD",
            "identifier": "PT1604",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14547194",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Izard Regional Hospital LLC
• Izard Regional Hospital LLC (IRH Medical Group)
• Jackie Cheatham (Ozark EMS)
• Catherine Marie Janusz, PTA
• Bethany Lane Knight, M.D.
• John Tipton Lane, D.D.S.
• Robert C Lane, M.D.
• Kari Anne Lindsey, FNP
• Patrick Joe Martz, PTA
• Jennifer Bernadean Massey, PT

• Physical Therapist in Calico Rock, AR
• Providers in Calico Rock, AR by specialty
• Physical Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; 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.