DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: KEVIN P SCULLY PAC

MEDICARE: KEVIN P SCULLY PAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA03374TX

General Provider Information

NPI Number : 1730199563
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEVIN P SCULLY PAC
Provider Business Mailing Address
First Line : 2210 THREE LAKES PKWY STE 100
Second Line :
City : TYLER
State : TX
Zip : 75703-0642
Country : US
Telephone Number : 903-747-4050
Fax Number : 903-747-4075
Provider Business Practice Location Address
First Line : 2210 THREE LAKES PKWY STE 100
Second Line :
City : TYLER
State : TX
Zip : 75703-0642
Country : US
Telephone Number : 903-747-4050
Fax Number : 903-747-4075
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2006
Last Update Date : 02/05/2026

Similar Medicare Providers

1215972591 — BRYAN TODD HYLAND MD
Practice Location Address:
2210 THREE LAKES PKWY STE 100
TYLER, TX
75703-0642
Practice Phone: 903-747-4050
Practice Fax: 903-747-4075
1669402715 — ALLISON DAWN CLEMENTS PA
Practice Location Address:
2210 THREE LAKES PKWY STE 100
TYLER, TX
75703-0642
Practice Phone: 903-747-4050
Practice Fax: 903-747-4075
1609982420 — DR. KATHERINE E BOWMAN AUD
Practice Location Address:
2210 THREE LAKES PKWY STE 100
TYLER, TX
75703-0642
Practice Phone: 903-747-4050
Practice Fax:
1346462496 — CHRISTOPHER A PERRO MD
Practice Location Address:
2210 THREE LAKES PKWY STE 100
TYLER, TX
75703-0642
Practice Phone: 903-747-4050
Practice Fax: 903-747-4075
1871751636 — DR. AMANDA GAYLE EDWARDS AUD
Practice Location Address:
2210 THREE LAKES PKWY STE 100
TYLER, TX
75703-0642
Practice Phone: 903-747-4050
Practice Fax:
1134516172 — KURTIS KOSTAN MD
Practice Location Address:
2210 THREE LAKES PKWY STE 100
TYLER, TX
75703-0642
Practice Phone: 903-747-4050
Practice Fax: 903-747-4075

Directions to “ KEVIN P SCULLY PAC” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.