Active NPI
Kathleen M Marty, PA-C
- Physician Assistant
- Roseville, CA
National Provider Identifier
1043315146
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA10584
- Practice address
- 3 Medical Plaza Dr
#140
Roseville, CA 95661-3087 - Phone
- (916) 797-4715
- Fax
- (916) 797-4716
- NPI assigned
- Sep 13, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA10584 | CA | Primary |
Addresses
Primary practice location
3 Medical Plaza Dr
#140
Roseville, CA 95661-3087
Mailing address
10470 Old Placerville Rd
Suite 100
Sacramento, CA 95827-2539
Phone (800) 470-0071
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10584 | CA | MD | Pediatric Optometrist |
| PA10584 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437955200000",
"number": "1043315146",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10470 OLD PLACERVILLE RD",
"address_2": "SUITE 100",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958272539",
"telephone_number": "800-470-0071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 MEDICAL PLAZA DR",
"address_2": "#140",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "956613087",
"telephone_number": "916-797-4715",
"fax_number": "916-797-4716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTY",
"first_name": "KATHLEEN",
"middle_name": "M",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-13",
"last_updated": "2015-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA10584",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.