Kendall Wyllie, MD

Primary specialty

Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X

License

64200 Issued in AZ

Practice address

3838 N Campbell Ave
Tucson, AZ 85719-1454

Phone

(520) 694-8888

NPI assigned

May 11, 2015

Sex

Female

Sole proprietor

No

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 AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pediatric MedicineAlso: Neurology

Education

University of Cincinnati College of Medicine, 2015

Medicare assignment

May accept Medicare assignment

Group practices

Children'S Clinics for Rehabilitative ServicesGroup PAC ID 2264503408, 22 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kwyllie398890@direct.saint-lukes.org

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.

• Children'S Clinics for Rehabilitative Services

  • Multi-Specialty Clinic/Center
  • Tucson, AZ
  • NPI 1063454346
  Medicare reassignment Care Compare group NPD
• Banner-University Medical Group

  • Multi-Specialty Clinic/Center
  • Phoenix, AZ
  • NPI 1508809427
  Medicare reassignment NPD
• Banner-University Medical Group

  • Nutrition Education Nutritionist
  • Tucson, AZ
  • NPI 1639842677
  NPD
• Banner-University Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Tucson, AZ
  • NPI 1922820935
  NPD

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

{
    "created_epoch": "1431302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632355200000",
    "number": "1922486984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3838 N CAMPBELL AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857191454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3838 N CAMPBELL AVE",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857191454",
            "telephone_number": "520-694-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYLLIE",
        "first_name": "KENDALL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-11",
        "last_updated": "2021-09-23",
        "certification_date": "2021-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "AZ",
            "license": "64200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa D Wyatt, AUD
• Amber Rae Wychers
• Katelynn Wychulis
• Devin Wycoff
• Michelle Renae Wylie, PHARMD
• Michael Thornton Wyman, MD
• Carole Jeanne Wymer Jensen, M.S.
• Colleen Wypych, RN IBCLC
• X-Press Transport
• Xavier Martinez M.D.,P.C.

• Neurology with Special Qualifications in Child Neurology Physician in Tucson, AZ
• Providers in Tucson, AZ by specialty
• Neurology with Special Qualifications in Child Neurology Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.
• 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.