Individual provider Active NPI

Kayla Hersey

  • Medical Physician Assistant
  • Providence, RI
National Provider Identifier
1336879188
Registry record updated Jun 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA01473 Issued in RI
Practice address
164 Summit Ave
Providence, RI 02906-2853
Phone
(401) 793-3550
NPI assigned
Jun 14, 2022
Last updated
Jun 14, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X PA01473 RI Primary

Addresses

Primary practice location

164 Summit Ave
Providence, RI 02906-2853

Mailing address

1535 Atwood Ave Apt 106
Johnston, RI 02919-3232
Phone (401) 263-9291

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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
I20220826002635 RI Practitioner - Physician Assistant 7113301086 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians

Practice addresses (Care Compare)

164 Summit Ave
Providence, RI 02906-2853

185 A High Service Ave
North Providence, RI 02904-5114
Phone (401) 354-6050

185 High Service Ave
North Providence, RI 02904-5114
Phone (401) 354-6050

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA01473RIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Lifespan Physician Group, Inc. CurrentSince Sep 6, 2022 Accepting new patients
The Miriam Hospital CurrentSince Sep 6, 2022 Accepting new patients
Lifespan Physician Group, Inc. Medical CurrentSince Sep 6, 2022 Accepting new patients
The Miriam Hospital Current Accepting new patients
The Miriam Hospital Current Accepting new patients
The Miriam Hospital CurrentSince Sep 6, 2022 Accepting new patients

Locations

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

164 Summit Ave
Providence, RI 02906
Phone (401) 793-2104

208 Collyer St
Ste 100
Providence, RI 02904
Phone (401) 793-7191

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1655164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1336879188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1535 ATWOOD AVE APT 106",
            "city": "JOHNSTON",
            "state": "RI",
            "postal_code": "029193232",
            "telephone_number": "401-263-9291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "164 SUMMIT AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029062853",
            "telephone_number": "401-793-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERSEY",
        "first_name": "KAYLA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-14",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "RI",
            "license": "PA01473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Providence, RI

Sources for this page

Verify at the official NPI Registry.