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General NPI Number Information
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NPI Number | 1053421057
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Entity Type | Organization
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Legal Business Name | KAYE A CUNNINGHAM MD PC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5653 HWY 95 SUITE A
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City | FORT MOHAVE
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State | AZ
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Zip | 86426
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Country | US
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Telephone | 928-768-2558
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Fax | 928-788-2039
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Provider Business Mailing Address
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Address Line | PO BOX 8368
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City | FORT MOHAVE
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State | AZ
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Zip | 86427
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Country | US
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Telephone | 928-768-2558
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Fax | 928-788-2039
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Authorized Official
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Title or Position | ATTENDING PHYSICIAN
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Name | DR. KAYE AVARANN CUNNINGHAM
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Credential | MD PC
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Telephone | 928-768-2558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A71438
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | Z8326
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License Number State | AZ
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