Kathlyn Lara Penick, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9116046 Issued in FL

Practice address

2824 Enterprise Rd
Orange City, FL 32763-8428

Phone

(386) 774-7411

Fax

(386) 774-7412

NPI assigned

Jun 15, 2022

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

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

Practice roles

Locations

Networks

• Freedom Health HMO Network
• Optimum HealthCare HMO Network

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.

• Florida Cancer Specialists & Research Institute, LLC

  • Medical Oncology Physician
  • Cape Coral, FL
  • NPI 1760590962
  Medicare reassignment NPD
• Florida Cancer Specialists & Research Institute, LLC

  • Medical Oncology Physician
  • Bradenton, FL
  • NPI 1508973231
  NPD (past)
• Mid-Florida Cancer Centers LLC

  • Specialist
  • Orange City, FL
  • NPI 1255369955
  NPD (past)
• Mid-Florida Hematology & Oncology Centers, PA

  • Hematology & Oncology Physician
  • Deland, FL
  • NPI 1255753943
  NPD (past)

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

{
    "created_epoch": "1655251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783382400000",
    "number": "1558091157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 102222",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303682222",
            "telephone_number": "239-274-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2824 ENTERPRISE RD",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327638428",
            "telephone_number": "386-774-7411",
            "fax_number": "386-774-7412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENICK",
        "first_name": "KATHLYN",
        "middle_name": "LARA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-15",
        "last_updated": "2026-07-07",
        "certification_date": "2026-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9116046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alicia Cellini Payne
• Peak Athletix LLC
• Alyssa Ann Pearson
• Alfredo A Pegoraro, M.D.
• Jason Pemberton, PT, DPT
• Perez Health Care Group Inc
• Huberto Perez, M.D.
• Jasmine Perez, D.C.
• Chanelle Perrier
• Maria Renata Perrogon

• Physician Assistant in Orange City, FL
• Providers in Orange City, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2026; 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.