Crystal McKiddy, P.A

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA1887 Issued in KY

Practice address

14662 N US Highway 25 E
Corbin, KY 40701-6425

Phone

(606) 526-9005

Fax

(606) 526-8606

NPI assigned

Jan 6, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN, KY2 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

Specialty

Physician Assistant

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Grace Community Health Center, Inc.Group PAC ID 3870654064, 65 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cmckiddy@wfmc.gwaydirect.com
• Direct secure messaging: cmckiddy704206@direct.ochin.org

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.

• Grace Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Corbin, KY
  • NPI 1568625648
  Medicare reassignment Care Compare group NPD
• Fast Pace Medical Clinic PLLC

  • Family Medicine Physician
  • Spring Hill, TN
  • NPI 1134452865
  Medicare reassignment NPD
• Emergency Coverage Services, PC

  • Nurse Practitioner
  • Lawrenceburg, TN
  • NPI 1053351593
  Medicare reassignment
• Mountain Peoples Health Councils Inc

  • Federally Qualified Health Center (FQHC)
  • Oneida, TN
  • NPI 1871594333
  Medicare reassignment
• Southeastern Emergency Services P C

  • Nurse Practitioner
  • Athens, TN
  • NPI 1669414264
  Medicare reassignment
• Grace Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Corbin, KY
  • NPI 1316645344
  NPD
• Fast Pace Medical Clinic PLLC

  • Rural Health Clinic/Center
  • Chapel Hill, TN
  • NPI 1316602774
  NPD
• Mountain Peoples Health Councils Inc

  • Federally Qualified Health Center (FQHC)
  • Huntsville, TN
  • NPI 1720043615

  Physician Assistant

  NPD
• Mountain Peoples Health Councils Inc.

  • Federally Qualified Health Center (FQHC)
  • Huntsville, TN
  • NPI 1326049347
  NPD

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

{
    "created_epoch": "1325808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710288000000",
    "number": "1568732618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 EDGEWOOD DR",
            "city": "WILLIAMSBURG",
            "state": "KY",
            "postal_code": "407691559",
            "telephone_number": "423-215-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14662 N US HIGHWAY 25 E",
            "city": "CORBIN",
            "state": "KY",
            "postal_code": "407016425",
            "telephone_number": "606-526-9005",
            "fax_number": "606-526-8606"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "19536 Alberta St",
            "address_purpose": "LOCATION",
            "city": "Oneida",
            "state": "TN",
            "postal_code": "378413382",
            "country_code": "US",
            "telephone_number": "423-569-3278",
            "fax_number": "423-569-4414",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCKIDDY",
        "first_name": "CRYSTAL",
        "credential": "P.A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-06",
        "last_updated": "2024-03-13",
        "certification_date": "2024-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "2075",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "KY",
            "license": "PA1887",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1527317",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kahlan McFerron
• Pamela Farrar McGeorge, LCSW
• Kateshia Michelle McIntosh
• Jamie McKeehan
• Thomas Earl McKeehan Jr., BS
• Michelle Lynn McKinney, MA
• Jason McNeill
• Beth McQueen
• Morgan Brittany McQueen, BS
• Tiffany McQueen

• Medical Physician Assistant in Corbin, KY
• Providers in Corbin, KY by specialty
• Medical Physician Assistant in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.