Kimberly A Rericha, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

50-002407 Issued in OH

Practice address

18901 Lake Shore Blvd
Euclid, OH 44119-1078

Phone

(216) 531-9000

NPI assigned

Feb 28, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kimberly A Micknowski Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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

• Gastroenterology of Akron, Inc.

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  NPD (past)
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  NPD (past)

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

{
    "created_epoch": "1141084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1073589180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 74253",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441940002",
            "telephone_number": "440-879-0081",
            "fax_number": "440-879-0084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18901 LAKE SHORE BLVD",
            "city": "EUCLID",
            "state": "OH",
            "postal_code": "441191078",
            "telephone_number": "216-531-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RERICHA",
        "first_name": "KIMBERLY",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-28",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50-002407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "MICKNOWSKI",
            "middle_name": "A",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physician Assistant in Euclid, OH
• Providers in Euclid, OH by specialty
• Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.