Kathleen Yancey, RD, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9115044 Issued in FL

Practice address

906 Park Ave
Orange Park, FL 32073-4120

Phone

(904) 541-0315

Fax

(904) 541-0316

NPI assigned

Aug 19, 2021

Last updated

Nov 8, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Park Avenue Dermatology PAGroup PAC ID 7517979933, 14 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

88.5 of 100Reported as group

Quality

100

Improvement activities

40

Cost

61.65

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kyancey@directaddress.net
• Direct secure messaging: kyancey@pad.emadirect.md

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Park Avenue Dermatology PA

  • Dermatology Physician
  • Orange Park, FL
  • NPI 1205871001
  Medicare reassignment Care Compare group
• Gil a Cu MD LLC

  • Nephrology Physician
  • Jacksonville, FL
  • NPI 1326827569
  NPD (past)
• Mary E. Schmieder DO. Facep, Inc

  • Emergency Medicine Physician
  • Orange Park, FL
  • NPI 1396829347
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1629331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636329600000",
    "number": "1053087114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "929 IRONRIDGE CT",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320655747",
            "telephone_number": "904-614-0670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 PARK AVE",
            "city": "ORANGE PARK",
            "state": "FL",
            "postal_code": "320734120",
            "telephone_number": "904-541-0315",
            "fax_number": "904-541-0316"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "929 Ironridge Ct",
            "address_purpose": "LOCATION",
            "city": "Orange Park",
            "state": "FL",
            "postal_code": "320655747",
            "country_code": "US",
            "telephone_number": "904-614-0670",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YANCEY",
        "first_name": "KATHLEEN",
        "credential": "RD, PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-19",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9115044",
            "primary": true
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND7019",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna H. Wynn, ARNP
• Keesha Wynn, CD
• Xtra Helping Hands and Hearts LLC
• Xtreme Natural Body
• Gernell Yamada
• Leon A Yasay Jr., MD
• Jennifer Yaxley, PA
• Stacey Yearian, PTA
• Joshua Mark Yeykal, D.O.
• Amanda Lane Yoachum, LMT

• Physician Assistant in Orange Park, FL
• Providers in Orange Park, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.