Kemberly Amanda Stone, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

05480 Issued in GA

Practice address

453 Lakes Blvd Suite B
Lake Park Family Care Clinic
Lake Park, GA 31636

Phone

(229) 588-2866

NPI assigned

Mar 6, 2007

Last updated

Mar 2, 2018By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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

State licenses

Practice roles

Locations

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.

• Richard Wa Rickman LLC

  • Preferred Provider Organization
  • Valdosta, GA
  • NPI 1790147908
  NPD

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1519948800000",
    "number": "1639208333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "453 LAKES BLVD",
            "address_2": "SUITE B",
            "city": "LAKE PARK",
            "state": "GA",
            "postal_code": "316366607",
            "telephone_number": "229-588-2866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "453 LAKES BLVD SUITE B",
            "address_2": "LAKE PARK FAMILY CARE CLINIC",
            "city": "LAKE PARK",
            "state": "GA",
            "postal_code": "31636",
            "telephone_number": "229-588-2866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STONE",
        "first_name": "KEMBERLY",
        "middle_name": "AMANDA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-06",
        "last_updated": "2018-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "05480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA MEDICAL LICENSE NUMBER: 05480  EXPIRATION 01/31/2016",
            "identifier": "05480",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• South Georgia Radiology Consultants, PC
• South Health District (Lowndes Co Board of Health - Lake Park Clinic)
• Murray Geronamo Starling
• Megan Stewart
• Summer Megan Stokes, FNP-BC
• The Children's Learning Hub, LLC
• Ansley Madison Tillman
• Rich Vodde, PHD SOCIAL
• Deborah Ann Woodward

• Physician Assistant in Lake Park, GA
• Providers in Lake Park, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2018; 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.