Provider Demographics
NPI:1447435417
Name:CUNNINGHAM, KAYE A (MD)
Entity type:Individual
Prefix:
First Name:KAYE
Middle Name:A
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8368
Mailing Address - Street 2:
Mailing Address - City:FORT MOHAVE
Mailing Address - State:AZ
Mailing Address - Zip Code:86427-8368
Mailing Address - Country:US
Mailing Address - Phone:928-768-2558
Mailing Address - Fax:
Practice Address - Street 1:5653 S HIGHWAY 95
Practice Address - Street 2:STE A
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-6068
Practice Address - Country:US
Practice Address - Phone:928-768-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ514704Medicaid
AZ514704Medicaid
AZZ69189Medicare PIN