Kyle Kreulen

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-907 Issued in AR

Practice address

3714 Grand Oaks Dr
Benton, AR 72019-2045

Phone

(501) 517-7004

NPI assigned

Feb 14, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

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

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.

• Uhs of Benton, LLC

  • Psychiatric Hospital
  • Benton, AR
  • NPI 1063482735
  Medicare reassignment

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

{
    "created_epoch": "1550102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631232000000",
    "number": "1912463902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3714 GRAND OAKS DR",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720192045",
            "telephone_number": "501-517-7004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3714 GRAND OAKS DR",
            "city": "BENTON",
            "state": "AR",
            "postal_code": "720192045",
            "telephone_number": "501-517-7004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KREULEN",
        "first_name": "KYLE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-02-14",
        "last_updated": "2021-09-10",
        "certification_date": "2021-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "AR",
            "license": "PA-907",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "PA-907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Aaron Koon II
• Mary Jo Koper, RN
• Megan Kosinski, RECOVERY ASSISTANT
• Luke Kramer, CMP
• Chloe Krebs
• Kimberly Krippendorf, RECOVERY ASSISTANT
• Anna Elizabeth Krizman, M.S. SLP-CF
• Kroger Limited Partnership I
• Kroger Limited Partnership I
• Stacey Kuchinski, LCSW

• Physician Assistant in Benton, AR
• Providers in Benton, AR by specialty
• Physician Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2021; 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.