Kim Marie Latterner, PA-C

Key facts

NPI

1356359889

Entity type

Individual (NPI type 1)

Primary specialty

Medical Physician Assistant 363AM0700X

License

MA001899L (PA)

Practice address

115 Hickory Dr
Manchester, PA 17345-9502

Phone

(717) 266-6784

NPI assigned

Aug 3, 2006

Sex

Female

Sole proprietor

No

Organizations & group practices 1

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.

• Spirit Physician Services Inc. Diagnostic Radiology Physician · Camp Hill, PA · NPI 1275072662
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

HHS exclusion list flag

The National Provider Directory flags this NPI as appearing on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Physician Assistant

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

Other names

• Kim Marie Myers Former name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 19, 2011.

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324252800000",
    "number": "1356359889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 HICKORY DR",
            "city": "MANCHESTER",
            "state": "PA",
            "postal_code": "173459502",
            "telephone_number": "717-266-6784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 HICKORY DR",
            "city": "MANCHESTER",
            "state": "PA",
            "postal_code": "173459502",
            "telephone_number": "717-266-6784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LATTERNER",
        "first_name": "KIM",
        "middle_name": "MARIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-03",
        "last_updated": "2011-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C0002815",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA001899L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK BLUE SHIELD",
            "identifier": "1933965",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GATEWAY-WMG",
            "identifier": "1565458",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIM",
            "last_name": "MYERS",
            "middle_name": "MARIE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Manchester, PA

• James P. Tuttle, OD
• Kylie Keeney, MS, CCC-SLP
• Jena R. Khera, MD
• Derek Kramer, O.D.
• Kimberly N Kurland, D.O.
• Andrew L Leitzel, O.D.
• Laura Leigh Lenart, PHARMD
• Mainline Urgent Care Medical Group
• Alock Malik
• Manchester Ambulance Club

All providers in Manchester, PA · Medical Physician Assistant in Pennsylvania