Carley Johnah Dykstra, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2020000655 Issued in MO

Practice address

9556 Manchester Rd
Saint Louis, MO 63119-1313

Phone

(314) 961-2295

NPI assigned

Mar 6, 2020

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 names 1

• Carley Johnah Serowoky Former name

Medicare fee-for-service enrollment

Enrolled in MO, MI2 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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations (25 of 27)

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.

• Total Access Urgent Care, PC

  • Urgent Care Clinic/Center
  • Saint Louis, MO
  • NPI 1962684886
  Medicare reassignment NPD
• Hometown Urgent Care of Michigan, P.C.

  • Urgent Care Clinic/Center
  • Huber Heights, OH
  • NPI 1790030385

  MI

  Medicare reassignment NPD
• Total Access Urgent Care, PC

  • Urgent Care Clinic/Center
  • Saint Louis, MO
  • NPI 1952729402
  NPD
• Hometown Urgent Care of Michigan, P.C.

  • Clinical Medical Laboratory
  • Kalamazoo, MI
  • NPI 1891469631
  NPD
• Hometown Urgent Care of Michigan, PC

  • Clinical Medical Laboratory
  • Indianapolis, IN
  • NPI 1881358489
  NPD

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

{
    "created_epoch": "1583452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583452800000",
    "number": "1699300087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 APPLEGATE LN APT C",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630113225",
            "telephone_number": "248-904-5173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9556 MANCHESTER RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631191313",
            "telephone_number": "314-961-2295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYKSTRA",
        "first_name": "CARLEY",
        "middle_name": "JOHNAH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-06",
        "last_updated": "2020-03-06",
        "certification_date": "2020-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2020000655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARLEY",
            "last_name": "SEROWOKY",
            "middle_name": "JOHNAH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jessica Lynne Dyer, MSW, LCSW
• Pawel Tadeusz Dyk, M.D.
• Ryan William Dyke
• Alyson Genee Dykes, AGNP
• Mark S Dykewicz, MD
• Dymone'S Home Health Care LLC
• Dynamic Joy Home Health LLC
• Dynamic Rehab
• Dynamic Rehab LLC
• Dynasty Staffing Solutions LLC

• Physician Assistant in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Physician Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.