Individual provider Active NPI

Kaylie Poehlmann, PA-C

  • Physician Assistant
  • Fort Worth, TX
National Provider Identifier
1558062786
Registry record updated Mar 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
7217 Water Meadows Dr
Fort Worth, TX 76123-2826
Phone
(970) 396-7764
NPI assigned
Mar 14, 2023
Last updated
Mar 14, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2023

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 Primary

Addresses

Primary practice location

7217 Water Meadows Dr
Fort Worth, TX 76123-2826

Mailing address

7217 Water Meadows Dr
Fort Worth, TX 76123-2826
Phone (970) 396-7764

Other names 1

  • Kaylie Angus Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20230804003718 TX Practitioner - Physician Assistant 4486015567 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group CurrentSince Aug 1, 2023 Accepting new patients
Texas Health Physicians Group CurrentSince Aug 1, 2023 Accepting new patients

Locations

4333 N Josey Ln
Ste 104
Carrollton, TX 75010
Phone (972) 394-4500

2900 N Interstate 35
Ste 200
Denton, TX 76201
Phone (940) 323-3400

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, 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": "1678752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678752000000",
    "number": "1558062786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7217 WATER MEADOWS DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761232826",
            "telephone_number": "970-396-7764"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7217 WATER MEADOWS DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761232826",
            "telephone_number": "970-396-7764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POEHLMANN",
        "first_name": "KAYLIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-14",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAYLIE",
            "last_name": "ANGUS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.