Individual provider Active NPI

Kaitlyn Nicole McMahon

  • Advanced Practice Midwife
  • Ukiah, CA
National Provider Identifier
1407606064
Registry record updated Jul 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
236462 Issued in CA
Practice address
333 Laws Ave
Ukiah, CA 95482-6540
Phone
(707) 468-1010
NPI assigned
Mar 26, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X 236462 CA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

333 Laws Ave
Ukiah, CA 95482-6540

Mailing address

234 Bluff View Dr
Lancaster, PA 17601-4136
Phone (717) 925-9742

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240929000116 CA Practitioner - Certified Nurse Midwife (CNM) 5496286692 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

Practice roles

OrganizationSpecialtyStatusNew patients
Mendocino Community Health Clinic, Inc. CurrentSince Sep 1, 2024 Accepting new patients
Mendocino Community Health Clinic, Inc. Current Accepting new patients
Mendocino Community Health Clinic, Inc. Past Accepting new patients

Locations

333 Laws Ave
Ukiah, CA 95482
Phone (707) 463-1113

Interoperability endpoints

  • Direct secure messaging: kmcmahon731829@direct.ochin.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1711411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1407606064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 BLUFF VIEW DR",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176014136",
            "telephone_number": "717-925-9742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 LAWS AVE",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954826540",
            "telephone_number": "707-468-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCMAHON",
        "first_name": "KAITLYN",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-26",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "CA",
            "license": "236462",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ukiah, CA

Sources for this page

Verify at the official NPI Registry.