Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kevin P Scully, PAC

Individual provider Physician Assistant · NPI 1730199563

Kevin P Scully, PAC is a Physician Assistant in Tyler, Texas. Qualified in 2006, 20 years ago. Practices with Etmc Physician Group, Inc, a 376-clinician group and accepts Medicare assignment. Licensed in Texas.

Years since qualifying
20
Licensed in
TX
In the registry since
2006
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

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Practice location Address checks out

2210 Three Lakes Pkwy Ste 100
Tyler, TX 75703-0642
Phone: (903) 747-4050
Fax: (903) 747-4075
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA03374 (TX)

Record details

NPI number1730199563
Entity typeIndividual (Type 1)
GenderMale
Credentials PAC
Sole proprietorNo
NPI enumeratedAugust 8, 2006
Last updated in NPPESFebruary 5, 2026
Certification dateFebruary 5, 2026
Mailing address2210 Three Lakes Pkwy Ste 100, Tyler, TX 75703-0642

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2006 (20 years in practice)
Group practice Etmc Physician Group, Inc. — 376 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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