Individual provider Active NPI

Katherine Nicole Skraba, PA

  • Physician Assistant
  • Fort Walton Beach, FL
National Provider Identifier
1477264257
Registry record updated May 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
1000 Mar Walt Dr
Fort Walton Beach, FL 32547-6708
Phone
(850) 862-1111
NPI assigned
Dec 12, 2022
Last updated
May 21, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X FL Primary

Addresses

Primary practice location

1000 Mar Walt Dr
Fort Walton Beach, FL 32547-6708

Mailing address

1933 Noleka CT
Navarre, FL 32566-3034
Phone (850) 381-3490

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20230322000316 FL Practitioner - Physician Assistant 3274907845 Reassigns benefits to 2 organizations
I20241204001158 WA Practitioner - Physician Assistant 3274907845 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
FL-I Medical Services LLC Physician Assistant CurrentSince Feb 1, 2023 Accepting new patients
FL-I Medical Services LLC Physician Assistant CurrentSince Feb 1, 2023 Accepting new patients

Locations

322 SW Pine Island Rd
Cape Coral, FL 33991
Phone (941) 249-6858

996 Airport Rd
Destin, FL 32541
Phone (615) 338-1250

1000 Mar Walt Dr
Ft Walton Bch, FL 32547
Phone (850) 374-9610

20900 Biscayne Blvd
Miami, FL 33180
Phone (305) 682-7290

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1670803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716249600000",
    "number": "1477264257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1933 NOLEKA CT",
            "city": "NAVARRE",
            "state": "FL",
            "postal_code": "325663034",
            "telephone_number": "850-381-3490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MAR WALT DR",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476708",
            "telephone_number": "850-862-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SKRABA",
        "first_name": "KATHERINE",
        "middle_name": "NICOLE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-12",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Walton Beach, FL

Sources for this page

Verify at the official NPI Registry.