Individual provider Active NPI

Kaitlynd Nicole Hanna, P.A.

  • Physician Assistant
  • Lorain, OH
National Provider Identifier
1609563782
Registry record updated Oct 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.008429RX Issued in OH
Practice address
6150 Park Avenue Dr.
Ste. B
Lorain, OH 44053-4153
Phone
(440) 984-6499
Fax
(234) 757-7545
NPI assigned
Apr 19, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.008429RX OH Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

6150 Park Avenue Dr.
Ste. B
Lorain, OH 44053-4153

Mailing address

2000 Auburn Dr.
Ste. 350
Beachwood, OH 44122-4327
Phone (440) 646-1600

Other identifiers 1

IdentifierTypeStateIssuer
0036653MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20240118000440 OH Practitioner - Physician Assistant 8527410299 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Apex Dermatology and Skin Surgery Center, LLCGroup PAC ID 1052589777, 52 clinicians

Practice addresses (Care Compare)

36855 American Way
Avon, OH 44011-4054
Phone (440) 696-7546

4350 Crocker Rd
Suite 300
Westlake, OH 44145-6329
Phone (440) 646-1600

6150 Park Square Dr
Suite B
Lorain, OH 44053-4153
Phone (440) 984-6499

7580 Auburn Rd
Suite 301
Painesville, OH 44077-9618
Phone (440) 352-7546

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50.008429RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
SCH Professional Corporation Past Accepting new patients
Gary R Kutsikovich MD and Associates Inc Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kbudzik@apexskin.emadirect.md
  • Direct secure messaging: kbudzik565451@ehrdirect.uhhospitals.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1681862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761004800000",
    "number": "1609563782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 AUBURN DR.",
            "address_2": "STE. 350",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441224327",
            "telephone_number": "440-646-1600",
            "fax_number": "440-646-1505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6150 PARK AVENUE DR.",
            "address_2": "STE. B",
            "city": "LORAIN",
            "state": "OH",
            "postal_code": "440534153",
            "telephone_number": "440-984-6499",
            "fax_number": "234-757-7545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNA",
        "first_name": "KAITLYND",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-19",
        "last_updated": "2025-10-21",
        "certification_date": "2025-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.008429RX",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0036653",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lorain, OH

Sources for this page

Verify at the official NPI Registry.