Kaitlyn Dickert, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

9112407 Issued in FL

Practice address

1250 N Vantage Point Dr
Crystal River, FL 34429-5736

Phone

(352) 795-0644

NPI assigned

Jan 21, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Meadowcrest Family Physicians, P.a.

  • Family Medicine Physician
  • Crystal River, FL
  • NPI 1396981528
  Medicare reassignment

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

{
    "created_epoch": "1453334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583366400000",
    "number": "1396102307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 N VANTAGE POINT DR",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344295736",
            "telephone_number": "352-795-0644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 N VANTAGE POINT DR",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344295736",
            "telephone_number": "352-795-0644"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6199 W Gulf to Lake Hwy",
            "address_purpose": "LOCATION",
            "city": "Crystal River",
            "state": "FL",
            "postal_code": "34429",
            "country_code": "US",
            "telephone_number": "352-795-0644",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9360 W Far Hills Ln",
            "address_purpose": "LOCATION",
            "city": "Crystal River",
            "state": "FL",
            "postal_code": "344286420",
            "country_code": "US",
            "telephone_number": "352-634-0797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DICKERT",
        "first_name": "KAITLYN",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-01-21",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND7665",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "9112407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shanta Devaughn
• DH Pritchard MD PA
• Alex Jonathan Dickert, M.D.
• Amanda Carroll Dickert, ARNP
• Jim C Dickert, DO
• Ryan Spencer Dickert, MD
• Mark Allen Dietrich, MA
• Virginia Dohn
• Maxfelonilo A Domingo, MD
• Donald H Pritchard MD PA

• Medical Physician Assistant in Crystal River, FL
• Providers in Crystal River, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.