Katelyn McCluskey Liles, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA00605 Issued in MS

Practice address

2778 Highway 51 S
Senatobia, MS 38668-9403

Phone

(662) 560-5966

NPI assigned

Oct 25, 2021

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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: katelyn.liles.2@17263.direct.athenahealth.com

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.

• Archipoimen PLLC

  dba Bagwell Medical Clinic

  • Clinic/Center
  • Hernando, MS
  • NPI 1881119618
  Medicare reassignment
• Associated Family Medical, LLC

  • Nurse Practitioner
  • Senatobia, MS
  • NPI 1194054304
  NPD

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

{
    "created_epoch": "1635120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635120000000",
    "number": "1144984451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2778 HIGHWAY 51 S",
            "city": "SENATOBIA",
            "state": "MS",
            "postal_code": "386689403",
            "telephone_number": "662-560-5966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2778 HIGHWAY 51 S",
            "city": "SENATOBIA",
            "state": "MS",
            "postal_code": "386689403",
            "telephone_number": "662-560-5966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILES",
        "first_name": "KATELYN",
        "middle_name": "MCCLUSKEY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-25",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MS",
            "license": "PA00605",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSISTANT",
            "identifier": "PA00605",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kamlesh Parekh
• Bailey Rae Kargo, OD
• Hana Kayali, DDS
• Lindsey Kay Kossan, RPH
• Lee Family Dentistry, PA
• James W Litton II, ACNP
• Olivia Lorayne Lloyd, OTR
• LM Burnett Health Services, Inc (Preventive Care Health and Wellness)
• Donica Long, FNP
• Alyssa Mabry, OD

• Medical Physician Assistant in Senatobia, MS
• Providers in Senatobia, MS by specialty
• Medical Physician Assistant in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.