DERIK K KENWORTHY (NPI# 1861726077) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861726077 |
| Entity Type | Individual |
| Full Name | DERIK K KENWORTHY |
| Credential | P.A. |
| Practice Address |
1979 W Ray Rd Chandler AZ 85224-4007 |
| Mailing Address |
1250 S Clearview Ave Ste 100 Mesa AZ 85209-3378 |
| Practice Telephone | 4808219404 |
| Practice Fax Number | 4808571490 |
| Mailing Telephone | 4809889108 |
| Mailing Fax Number | 4808134460 |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2015-04-16 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 4489 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 503865 | 05 | |
| MEDICARE PTAN | Z173125 | 01 |
| Street Address |
1979 W RAY RD |
| City | CHANDLER |
| State | AZ |
| Zip Code | 85224-4007 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194368993 | Banner Occupational Health Arizona LLC | Clinic/Center | 1979 W Ray Rd, Chandler, AZ 85224-4007 | 2019-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245878859 | Optum Infusion Services 308, LLC | Durable Medical Equipment & Medical Supplies | 460 S. Benson Lane, Ste. 11-12, Chandler, AZ 85224 | 2019-12-13 |
| 1073172037 | Brennan Allen | Dentist | 610 N Alma School Rd Ste 4, Chandler, AZ 85224 | 2019-06-12 |
| 1518525237 | Rachel Kelly Mador-house | Genetic Counselor, MS | 685 & 695 S Dobson Rd, Chandler, AZ 85224 | 2019-05-29 |
| 1780249748 | Julia Solomon, Md | Obstetrics & Gynecology | 1725 West Frye Road, Suite 120, Chandler, AZ 85224 | 2019-05-06 |
| 1487118717 | Litonrx LLC | Pharmacy | 2080 N. Dobson Road, Suite 3, Chandler, AZ 85224 | 2019-01-31 |
| 1528556495 | Stone Med, LLC | Physical Medicine & Rehabilitation | 77 S Dobson Rd., Phoenix, AZ 85224 | 2018-04-26 |
| 1144739079 | Four Peaks Anesthesia Consultants, LLC | Anesthesiology | 1900 W Chandler Blvd Ste 15-257, Chandler, AZ 85224 | 2017-09-22 |
| 1275061350 | Whitney Carter | Behavioral Analyst | 3200 N Dobson Rd Ste F-1, Chandler, AZ 85224 | 2017-06-01 |
| 1528509171 | Angela M. Navarrete | Specialist/Technologist, Other | 1586 W Maggio Way Apt 2005, 2005, Chandler, AZ 85224 | 2017-03-15 |
| 1063958288 | Glover Family Medical, LLC | Clinic/Center | 901 S Alma School Rd, Apt. 20, Chandler, AZ 85224 | 2017-01-11 |
| Find all providers in zip 85224 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538719166 | Hope M Jones | Physician Assistant | 1300 N Mcclintock Dr Ste B4, Chandler, AZ 85226-7241 | 2019-09-16 |
| 1124503909 | Nina Novakovic | Physician Assistant | 604 W Warner Rd Ste E101, Chandler, AZ 85225-2909 | 2018-09-27 |
| 1497237085 | Sean Austin Eddy | Physician Assistant | 1211 E Binner Dr, Chandler, AZ 85225-1498 | 2018-08-30 |
| 1821570482 | Bethany Ann Tennyson | Physician Assistant | 875 S Dobson Rd Ste 1, Chandler, AZ 85224-5720 | 2018-08-30 |
| 1932619822 | Dorothyrose Francis Vowels | Physician Assistant | 1900 W Chandler Blvd Ste 15-255, Chandler, AZ 85224-6213 | 2017-10-04 |
| 1689194920 | Kyle D. Byrne | Physician Assistant | 1100 S Dobson Rd Ste 203, Chandler, AZ 85286 | 2017-06-27 |
| 1801334057 | Laura Witte | Physician Assistant | 1593 W Browning Way, Chandler, AZ 85286-0908 | 2017-02-08 |
| 1164853578 | Cole Bewley | Physician Assistant | 2745 S. Alma School Rd. Ste 3, Chandler, AZ 85286 | 2013-12-10 |
| 1528216371 | Maura Bridget Tardif | Physician Assistant | 5505 W Chandler Blvd Ste B13, Chandler, AZ 85226-3681 | 2008-09-05 |
| 1326216136 | Mika Hakkarainen | Physician Assistant | 4722 W Carla Vista Dr, Chandler, AZ 85226-2915 | 2008-02-14 |
| Find all providers in CHANDLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.