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Contact Information

KEVIN P SCULLY, PAC
5605 OLD BULLARD ROAD
B
TYLER, TX75703
 Phone: 903-630-5595
 Fax: 903-630-5599
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Physician Assistant

363A00000X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for KEVIN P SCULLY · (Male)

NPI Number 1730199563
Status Active
Credentials PAC
Entity Individual
Enumeration date 08/08/2006
Last updated 02/05/2026 - About 4 months ago
Sole proprietor 1 No
Identifiers
  • TX License # PA03374
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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