Active NPI
Katherine Ann Carroll, PA-C
- Physician Assistant
- Massapequa, NY
National Provider Identifier
1083955660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 009545-1
- Practice address
- 20 Hicksville Rd
Suite 2
Massapequa, NY 11758-5819 - Phone
- (516) 799-7500
- Fax
- (516) 799-2075
- NPI assigned
- Mar 7, 2013
- 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 | 009545-1 | NY | Primary |
Addresses
Primary practice location
20 Hicksville Rd
Suite 2
Massapequa, NY 11758-5819
Mailing address
20 Hicksville Rd
Suite 2
Massapequa, NY 11758-5819
Phone (516) 799-7500
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)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 003788 | GA | MD | Family Medicine Physician |
| 009545-1 | NY | MD | Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1362614400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362614400000",
"number": "1083955660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 HICKSVILLE RD",
"address_2": "SUITE 2",
"city": "MASSAPEQUA",
"state": "NY",
"postal_code": "117585819",
"telephone_number": "516-799-7500",
"fax_number": "516-799-2075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 HICKSVILLE RD",
"address_2": "SUITE 2",
"city": "MASSAPEQUA",
"state": "NY",
"postal_code": "117585819",
"telephone_number": "516-799-7500",
"fax_number": "516-799-2075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARROLL",
"first_name": "KATHERINE",
"middle_name": "ANN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-03-07",
"last_updated": "2013-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "009545-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Massapequa, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.