NPIMap

Organization Active NPI

Kinmed, P.a.

  • General Practice Physician
  • Estero, FL
National Provider Identifier
1992206155
Registry record updated Feb 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
KINMED, P.A.
Practice address
19910 S Tamiami TRL Ste C
Estero, FL 33928-4140
Phone
(239) 948-1222
Fax
(239) 948-1220
NPI assigned
Feb 23, 2018
Last updated
Feb 23, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2018

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

Authorized official

Name
Dr. Lyette Boucher, DC
Title
President
Phone
(239) 948-1222

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X FL
Pain Medicine (Anesthesiology) Physician 207LP2900X FL
General Practice Physician 208D00000X Primary
Physician Assistant 363A00000X FL

Addresses

Primary practice location

19910 S Tamiami TRL Ste C
Estero, FL 33928-4140

Mailing address

19910 S Tamiami TRL Ste C
Estero, FL 33928-4140
Phone (239) 948-1222

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1519344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1519344000000",
    "number": "1992206155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19910 S TAMIAMI TRL STE C",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "339284140",
            "telephone_number": "239-948-1222",
            "fax_number": "239-948-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19910 S TAMIAMI TRL STE C",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "339284140",
            "telephone_number": "239-948-1222",
            "fax_number": "239-948-1220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINMED, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-23",
        "last_updated": "2018-02-23",
        "status": "A",
        "authorized_official_last_name": "BOUCHER",
        "authorized_official_first_name": "LYETTE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-948-1222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "FL",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Estero, FL

Sources for this page

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