NPIMap

Individual provider Active NPI

Katie Beth Bennett, PA-C

  • Physician Assistant
  • Jacksonville, FL
National Provider Identifier
1235884305
Registry record updated Feb 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
12781 Issued in GA
Practice address
653 W 8TH St FL 2
Jacksonville, FL 32209-6511
Phone
(904) 244-7326
NPI assigned
Feb 17, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 3, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9115696 FL
Physician Assistant 363A00000X 12781 GA Primary

Addresses

Primary practice location

653 W 8TH St FL 2
Jacksonville, FL 32209-6511

Mailing address

13723 Atlantic Blvd Apt 432
Jacksonville, FL 32225-4235
Phone (813) 701-6379

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, CO, GA3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20220317002833 FL Practitioner - Physician Assistant 2860887494 Reassigns benefits to 1 organization
I20231013000377 CO Practitioner - Physician Assistant 2860887494 Reassigns benefits to 1 organization
I20250318003307 GA Practitioner - Physician Assistant 2860887494 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Florida International Univ, College of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Emory Clinic IncGroup PAC ID 8820901408, 3,507 clinicians

Practice addresses (Care Compare)

1365 Clifton Rd NE
Atlanta, GA 30322-1013
Phone (404) 778-7525

Hospital & facility affiliations

  • Emory University Hospital Hospital, Atlanta, GA, CCN 110010
  • Shands Jacksonville Hospital, Jacksonville, FL, CCN 100001
  • Emory University Hospital Midtown Hospital, Atlanta, GA, CCN 110078

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA9115696FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University of Florida Jacksonville Physicians, Inc. CurrentSince Mar 7, 2022 Accepting new patients
Boulder Medical Center, P.C. CurrentSince Aug 14, 2023 Accepting new patients
The Emory Clinic Inc CurrentSince Mar 12, 2025 Accepting new patients
University of Florida Jacksonville Physicians Inc CurrentSince Mar 7, 2022 Accepting new patients
Boulder Medical Center, P.C. CurrentSince Aug 14, 2023 Accepting new patients
The Emory Clinic Inc CurrentSince Mar 12, 2025 Accepting new patients
University of Florida Jacksonville Physicians, Inc. PastSince Feb 24, 2022 Accepting new patients

Locations

2750 Broadway St
Boulder, CO 80304
Phone (303) 440-3000

653 W 8th St
Fl 2
Jacksonville, FL 32209
Phone (904) 244-7281

655 W 8th St
Jacksonville, FL 32209
Phone (904) 244-1680

2201 Henderson Mill Rd NE
Ste 160
Atlanta, GA 30345
Phone (404) 251-2193

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

Interoperability endpoints

  • Direct secure messaging: kbennett1080055@direct.emory.org

Organizations & group practices 8

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 5

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": "1645056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738540800000",
    "number": "1235884305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13723 ATLANTIC BLVD APT 432",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322254235",
            "telephone_number": "813-701-6379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "653 W 8TH ST FL 2",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322096511",
            "telephone_number": "904-244-7326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT",
        "first_name": "KATIE",
        "middle_name": "BETH",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-02-17",
        "last_updated": "2025-02-03",
        "certification_date": "2025-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9115696",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "12781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.