Individual provider Active NPI

Kyle Dustin Kaufman, NP-C

  • Family Nurse Practitioner
  • Warner Robins, GA
National Provider Identifier
1366937930
Registry record updated Jan 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
RN204060 Issued in GA
Practice address
113 Willie Lee Pkwy
Warner Robins, GA 31088-8970
Phone
(478) 333-6688
Fax
(478) 333-6634
NPI assigned
Jun 26, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X RN204060 GA Primary

Addresses

Primary practice location

113 Willie Lee Pkwy
Warner Robins, GA 31088-8970

Mailing address

113 Willie Lee Pkwy
Warner Robins, GA 31088-8970
Phone (478) 333-6688

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20180913001137 GA Practitioner - Nurse Practitioner 6709136617 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Health Services of Central GeorgiaGroup PAC ID 9638076730, 300 clinicians

Practice addresses (Care Compare)

1120 Morningside Dr
Perry, GA 31069-2906
Phone (478) 987-3600

113 Willie Lee Pkwy
Warner Robins, GA 31088-8970
Phone (478) 333-6688

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Health Services of Central Georgia, Inc CurrentSince Dec 1, 2024 Accepting new patients

Locations

1120 Morningside Dr
Perry, GA 31069
Phone (478) 218-1706

113 Willie Lee Pkwy
Warner Robins, GA 31088
Phone (478) 333-6688

Interoperability endpoints

  • Direct secure messaging: kkaufman2957297@carolinashealthcaresystem.direct-ci.com

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.

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": "1529971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1366937930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 WILLIE LEE PKWY",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310888970",
            "telephone_number": "478-333-6688",
            "fax_number": "478-333-6634"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 WILLIE LEE PKWY",
            "city": "WARNER ROBINS",
            "state": "GA",
            "postal_code": "310888970",
            "telephone_number": "478-333-6688",
            "fax_number": "478-333-6634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAUFMAN",
        "first_name": "KYLE",
        "middle_name": "DUSTIN",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-26",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN204060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warner Robins, GA

Sources for this page

Verify at the official NPI Registry.