Individual provider Active NPI

Katelyn Evonne Skaggs, PA

  • Physician Assistant
  • Lexington, KY
National Provider Identifier
1114630118
Registry record updated Mar 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA3579 Issued in KY
Practice address
740 S Limestone Ste D135
Lexington, KY 40536-8269
Phone
(859) 323-5533
Fax
(859) 257-3634
NPI assigned
Jan 4, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA3579 KY
Medical Physician Assistant 363AM0700X PA3579 KY
Physician Assistant 363A00000X PA3579 KY Primary

Addresses

Primary practice location

740 S Limestone Ste D135
Lexington, KY 40536-8269

Mailing address

1507 Toney Fork Rd
Scarbro, WV 25917-8269

Other practice location 1

1507 Toney Fork Rd
Scarbro, WV 25917-8269
Phone (304) 663-6454

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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

Enrollment IDStateProvider typePAC IDDetails
I20241212002879 KY Practitioner - Physician Assistant 2062948169 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of KentuckyGroup PAC ID 3072425289, 778 clinicians
PT Pros, IncGroup PAC ID 0143139337, shared by 14 NPIs, 263 clinicians

Practice addresses (Care Compare)

101 Sanders-Brown BLDG
Lexington, KY 40536-0001
Phone (859) 257-1412

740 S Limestone
E214
Lexington, KY 40536-0001
Phone (859) 323-3368

770 Rose St
Mn328
Lexington, KY 40536-0001
Phone (859) 323-8873

792 Campbellsville Rd
Greensburg, KY 42743-1460
Phone (270) 973-5400

800 Rose St
Lexington, KY 40536-0001
Phone (859) 257-8562

800 Rose St
Lexington, KY 40536-7001
Phone (859) 257-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA3579KYMDMedical Physician Assistant
TC079KYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Kentucky CurrentSince Dec 3, 2024 Accepting new patients
University of Kentucky Past Accepting new patients

Locations

800 Rose St
Lexington, KY 40536
Phone (859) 257-8562

Organizations & group practices 2

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1672790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742515200000",
    "number": "1114630118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1507 TONEY FORK RD",
            "city": "SCARBRO",
            "state": "WV",
            "postal_code": "259178269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 S LIMESTONE STE D135",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405368269",
            "telephone_number": "859-323-5533",
            "fax_number": "859-257-3634"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1507 Toney Fork Rd",
            "address_purpose": "LOCATION",
            "city": "Scarbro",
            "state": "WV",
            "postal_code": "259178269",
            "country_code": "US",
            "telephone_number": "304-663-6454",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SKAGGS",
        "first_name": "KATELYN",
        "middle_name": "EVONNE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-04",
        "last_updated": "2025-03-21",
        "certification_date": "2025-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "KY",
            "license": "PA3579",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "PA3579",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "KY",
            "license": "PA3579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

Verify at the official NPI Registry.