MR. KEVIN E. MAYBERRY PA-C
NPI 1669780078
Physician Assistant - Medical in Fort Campbell, KY
About Mr. Kevin E. Mayberry Pa-c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. KEVIN E. MAYBERRY PA-C (NPI 1669780078) is an individual medical provider in Fort Campbell, Kentucky and active in the NPI registry since September 2010. He is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Mr. Kevin E. Mayberry Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
FORT CAMPBELL, KY 42223
FORT CAMPBELL, KY 42223
FORT CAMPBELL, KY 42223
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Kevin Mayberry's NPI number?
The NPI number for Kevin Mayberry is 1669780078. It was assigned to this individual provider in the NPPES registry on September 20, 2010.
Where is Kevin Mayberry located?
Kevin Mayberry practices at 650 Joel Dr, Fort Campbell, KY 42223. The listed phone number is (270) 798-3969.
What is Kevin Mayberry's specialty?
The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.
Is Kevin Mayberry enrolled in Medicare?
Yes. Kevin Mayberry is registered in the Medicare PECOS enrollment system.
When was this NPI record last updated?
The NPPES record for Kevin Mayberry was last updated on July 8, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Mr. Kevin E. Mayberry, PA-C · NPI 1669780078
Medical physician in Fort Campbell, Kentucky. Individual provider, active in the CMS NPPES registry since September 20, 2010.
## Identity
- **NPI:** 1669780078 (Entity type: Individual)
- **Enumerated:** September 20, 2010
- **Primary specialty:** Physician Assistant - Medical · taxonomy 363AM0700X
- **Sole proprietor:** Yes
## Practice location
- **Address:** 650 JOEL DR, Fort Campbell, KY 42223-5318
- **Phone:** (270) 798-3969
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for durable medical equipment, power mobility devices
## Record status
- **NPPES last updated:** July 8, 2022
- **Other identifiers:** Other PA0000003853 (TN)
---
Source: [NPI Profile](https://npiprofile.com/npi/1669780078) · Data from the CMS NPPES public registry.