Kaitlyn Jessica Shotwell, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-09512 Issued in NC

Practice address

2803 Medical Campus Drive
Seymour Johnson AFB, NC 27531

Phone

(919) 722-1802

Fax

(919) 722-4665

NPI assigned

Sep 27, 2019

Last updated

May 15, 2023By the provider in NPPES

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 identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Goldsboro Emergency Medical Specialists, Inc.

  • Emergency Medicine Physician
  • Goldsboro, NC
  • NPI 1164418232
  Medicare reassignment

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

{
    "created_epoch": "1569542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684108800000",
    "number": "1508417809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2803 MEDICAL CAMPUS DRIVE",
            "city": "SEYMOUR JOHNSON AFB",
            "state": "NC",
            "postal_code": "27531",
            "telephone_number": "919-722-1802",
            "fax_number": "919-722-4665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2803 MEDICAL CAMPUS DRIVE",
            "city": "SEYMOUR JOHNSON AFB",
            "state": "NC",
            "postal_code": "27531",
            "telephone_number": "919-722-1802",
            "fax_number": "919-722-4665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOTWELL",
        "first_name": "KAITLYN",
        "middle_name": "JESSICA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-27",
        "last_updated": "2023-05-15",
        "certification_date": "2023-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-09512",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC LICENSE",
            "identifier": "0010-09512",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Christopher Gary Keeton
• Rachel Eden Leigh Palmer, DO
• Jennifer Sullivan Price, LCSW
• Kristen Ricker
• Seymour Johnson Medical Group
• Conner Owen Sweet
• Jennifer Thomas, RN
• Coleman Woody, MD

• Physician Assistant in Seymour Johnson AFB, NC
• Providers in Seymour Johnson AFB, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; 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.