Kylie Elizabeth Campbell, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

19985 Issued in CA

Practice address

4921 Golden Foothill Pkwy
El Dorado Hills, CA 95762-9632

Phone

(916) 983-5771

Fax

(916) 939-1800

NPI assigned

Oct 26, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ms. Kylie Elizabeth Nuckols Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 1, 2020 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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.

• Dignity Health

  • General Acute Care Hospital
  • Folsom, CA
  • NPI 1356389878
  NPD (past)
• Kristine Burke MD, Inc.

  • Family Medicine Physician
  • Folsom, CA
  • NPI 1417179714
  NPD (past)

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

{
    "created_epoch": "1224979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590019200000",
    "number": "1558514281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5156",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957620003",
            "telephone_number": "530-400-9674",
            "fax_number": "916-939-1800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4921 GOLDEN FOOTHILL PKWY",
            "city": "EL DORADO HILLS",
            "state": "CA",
            "postal_code": "957629632",
            "telephone_number": "916-983-5771",
            "fax_number": "916-939-1800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1831 Orange Avenue",
            "address_2": "Suite C",
            "address_purpose": "LOCATION",
            "city": "Costa Mesa",
            "state": "CA",
            "postal_code": "92627",
            "country_code": "US",
            "telephone_number": "949-574-5800",
            "fax_number": "949-612-2725",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "KYLIE",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-10-26",
        "last_updated": "2020-05-21",
        "certification_date": "2020-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "19985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL ID NUMBER",
            "identifier": "952979638",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYLIE",
            "last_name": "NUCKOLS",
            "middle_name": "ELIZABETH",
            "prefix": "MS.",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Medical Physician Assistant in El Dorado Hills, CA
• Providers in El Dorado Hills, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.