Kin Med, PA

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

CH11313 Issued in FL

Legal business name

KIN MED, PA

Practice address

19910 S Tamiami Trail Ste C
Estero, FL 33928

Phone

(239) 948-1222

Fax

(239) 948-1221

NPI assigned

Mar 1, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Lyette Rose BoucherNPI 1104168194

Title

President

Phone

(239) 948-1222

Specialties & licenses 3

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lyette Boucher, DC

  • Chiropractor
  • Naples, FL
  • NPI 1104168194
  NPD (past) Authorized official

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

{
    "created_epoch": "1519862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519862400000",
    "number": "1861994204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19910 S. TAMIAMI TRAIL STE C",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "33928",
            "telephone_number": "239-948-1222",
            "fax_number": "239-948-1221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19910 S TAMIAMI TRAIL STE C",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "33928",
            "telephone_number": "239-948-1222",
            "fax_number": "239-948-1221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIN MED, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-01",
        "last_updated": "2018-03-01",
        "status": "A",
        "authorized_official_last_name": "BOUCHER",
        "authorized_official_first_name": "LYETTE",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-948-1222",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "CH11313",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": "CH11148",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "P.A.9104809",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nadia Ameena Kazim, M.D.
• Avonlea Malynn Keedy, DC
• Nicole Shuff Kennedy, CNP
• Kevin&Jean,Inc. (Actikare of Sw Florida)
• Kimberly Kimball
• Janis King, APRN
• Susan R. King, PSY.D.
• Kinmed, P.a.
• Reid Kirchhoff, MSED, LMHC
• Jessica Lynn Kirchner, PT

• General Practice Physician in Estero, FL
• Providers in Estero, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2018; 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.