1. Home
  2. Directory
  3. Texas
  4. Tyler
  5. Dermatology
  6. NPI Profile

DERMATOLOGY OF EAST TEXAS PA
NPI 1679905673
Dermatology in Tyler, TX

Active since August 01, 2013CLIA 45D2063115 · Microscopy
909 ESE LOOP323 STE 110, TYLER, TX 75701(903) 531-2850(903) 531-2875 Get Directions Write a Review

NPPES record last updated: June 10, 2025. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Jun 10, 2025, Oct 20, 2022 (2 updates tracked since 2022).

About Dermatology Of East Texas Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DERMATOLOGY OF EAST TEXAS PA (NPI 1679905673) is a healthcare organization registered as a dermatology in Tyler, Texas and active in the NPI registry since August 2013. The organization holds a CLIA Microscopy certificate valid through July 25, 2027 and lists Kyle David Jenkins, Coo, as its authorized official.

NPPES Registry Identity

NPI1679905673
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameDERMATOLOGY OF EAST TEXAS PA
Location Address909 ESE LOOP323 STE 110Tyler, TX 75701-9675
Mailing Address909 E Se Loop 323 Ste 110Tyler, TX 75701-9675 · (903) 531-2850 · Fax (903) 531-2875
Phone(903) 531-2850
Fax(903) 531-2875
Organization SubpartNo
Authorized OfficialKyle David JenkinsCoo · (903) 531-2850
Enumeration DateAugust 1, 2013
Last NPPES UpdateJune 10, 20252 updates tracked since enumeration
NPPES CertifiedJune 10, 2025
✔ NPI 1679905673 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
909 ESE LOOP323 STE 110, Tyler, TX 75701
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dermatology Of East Texas Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

5

Medicare enrollment records show 5 clinicians reassign Medicare billing to Dermatology Of East Texas PA, which bills Medicare for the services they deliver. Of these, 3 practice at this address and 4 within 10 miles. They are listed nearest first.

Clinicians, nearest first (5)

Megan Brown, MD
Dermatology
NPI 1386087617
909 ESE LOOP323 STE 110
Tyler, TX 75701
(903) 531-2850
✔ PECOSSame address
Alexandra Jenkins, MD
Dermatology
NPI 1912565193
909 E SOUTHEAST LOOP 323 STE 110
Tyler, TX 75701
(903) 531-2850
✔ PECOS✔ Accepts MedicareSame address
Lisa Lowry, MD
Dermatology
NPI 1326072653
909 ESE LOOP323 STE 110
Tyler, TX 75701
(903) 531-2850
✔ PECOSSame address
Kandiss Hearn, APRN, FNP-C
Nurse Practitioner
NPI 1336774405
2365 THREE LAKES PKWY
Tyler, TX 75703
(903) 991-4569
✔ PECOS✔ Accepts Medicare6.5 mi
Stephanie Davis, FNP
Dermatology
NPI 1497362198
1790 N STONEBRIDGE DR
Mckinney, TX 75071
(972) 390-9002
✔ PECOS✔ Accepts Medicare104 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 45D2063115

Dermatology Of East Texas, PA · Tyler, TX
Active · expires Jul 25, 2027
CLIA Number45D2063115
Laboratory TypePhysician Office
Certificate Effective DateJuly 26, 2025
Certificate Expiration DateJuly 25, 2027
Laboratory DirectorLisa R. Lowry
Laboratory Phone(903) 531-2850
Laboratory LocationDermatology Of East Texas, PA909 East SE Loop 323, Suite 110, Tyler, TX 75701
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

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 Dermatology Of East Texas PA's NPI number?

The NPI number for Dermatology Of East Texas PA is 1679905673. It was assigned to this organization in the NPPES registry on August 1, 2013.

Where is Dermatology Of East Texas PA located?

Dermatology Of East Texas PA is located at 909 Ese Loop323 Ste 110, Tyler, TX 75701. The listed phone number is (903) 531-2850.

What is Dermatology Of East Texas PA's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Is Dermatology Of East Texas PA enrolled in Medicare?

Yes. Dermatology Of East Texas PA is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Dermatology Of East Texas PA?

According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 2 Medicare specialties reassign their Medicare billing to Dermatology Of East Texas PA. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Dermatology (4) and Nurse Practitioner (1). Of these, 3 practice at this address and 4 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Dermatology Of East Texas PA hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 45D2063115) is associated with this NPI, valid through July 25, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Dermatology Of East Texas PA was last updated on June 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months 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.