Kayla C Martinez, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085-005185 Issued in IL

Practice address

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Phone

(309) 624-8818

Fax

(309) 624-8820

NPI assigned

Mar 20, 2015

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 names 1

• Kayla C Miller Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: kmartinez132776@direct.rush.rush-health.com

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

{
    "created_epoch": "1426809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461801600000",
    "number": "1366836033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-624-8818",
            "fax_number": "309-624-8820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-624-8818",
            "fax_number": "309-624-8820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINEZ",
        "first_name": "KAYLA",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-20",
        "last_updated": "2016-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-005185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAYLA",
            "last_name": "MILLER",
            "middle_name": "C",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Sara Ann Martin, FNP-BC
• Tabitha Danielle Martin, LCSW
• Derek Martinez, M.D.
• Edmundo A Martinez, M.D,
• Julio C Martinez, RN
• Mary A Marvin, ACNS BC
• Billy Ray Masco, MD
• Sean Masi, DO
• Joan L Mason, APN
• Vimal Master Sankar Raj, MD

• Physician Assistant in Peoria, IL
• Providers in Peoria, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.