Individual provider Active NPI

Katie Knight Waters, PA-C

  • Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1184273336
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9112252 Issued in FL
Practice address
4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone
(904) 953-2000
NPI assigned
Sep 10, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9112252 FL Primary

Addresses

Primary practice location

4500 San Pablo Rd S
Jacksonville, FL 32224-1865

Mailing address

PO Box 860912
Minneapolis, MN 55486-0912

Other practice location 1

7015 A C Skinner Pkwy Ste 1
Jacksonville, FL 32256-6932
Phone (904) 739-7779

Other practice location 2

700 3rd St Ste 302
Neptune Beach, FL 32266-5082
Phone (904) 997-3800

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kwaters2700044@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20191009001395 FL Practitioner - Physician Assistant 1759612567 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mayo Clinic JacksonvilleGroup PAC ID 5698689297, shared by 6 NPIs, 1,595 clinicians

Practice addresses (Care Compare)

4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone (904) 953-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
47.54 of 100Reported as apm
Quality
38.49
Promoting interoperability
0
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA9112252FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Clinical Practice Association Inc CurrentSince Oct 16, 2021 Accepting new patients
Cancer Specialists, LLC CurrentSince Nov 1, 2024 Accepting new patients
Florida Clinical Practice Association Inc CurrentSince Oct 16, 2021 Accepting new patients
Cancer Specialists, LLC CurrentSince Nov 1, 2024 Accepting new patients

Locations

2001 SW 13th St
Gainesville, FL 32608
Phone (352) 265-8990

1600 SW Archer Rd
Gainesville, FL 32610
Phone (352) 265-0077

5742 Booth Rd
Ste A
Jacksonville, FL 32207
Phone (904) 739-7779

7751 Belfort Pkwy
Ste 350
Jacksonville, FL 32256
Phone (904) 363-7453

7015 A C Skinner Pkwy
Ste 1
Jacksonville, FL 32256
Phone (904) 363-2113

700 3rd St
Ste 302
Neptune Beach, FL 32266
Phone (904) 997-3800

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 4

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 2

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": "1568073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1184273336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860912",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 SAN PABLO RD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322241865",
            "telephone_number": "904-953-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7015 A C Skinner Pkwy Ste 1",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322566932",
            "country_code": "US",
            "telephone_number": "904-739-7779",
            "fax_number": "904-739-7771",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "700 3rd St Ste 302",
            "address_purpose": "LOCATION",
            "city": "Neptune Beach",
            "state": "FL",
            "postal_code": "322665082",
            "country_code": "US",
            "telephone_number": "904-997-3800",
            "fax_number": "904-997-3899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATERS",
        "first_name": "KATIE",
        "middle_name": "KNIGHT",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-10",
        "last_updated": "2026-07-13",
        "certification_date": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kwaters2700044@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "4500 San Pablo Rd S",
            "city": "Jacksonville",
            "state": "FL",
            "country_code": "US",
            "postal_code": "322241865",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.