Individual provider Active NPI

Kaitlyn Ann Watkins, PA-C

  • Physician Assistant
  • Irvine, CA
National Provider Identifier
1780229955
Registry record updated Mar 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
9401 Jeronimo Rd
Irvine, CA 92618-1908
Phone
(760) 525-2593
NPI assigned
Nov 12, 2019
Reactivated
Feb 20, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X Primary

Addresses

Primary practice location

9401 Jeronimo Rd
Irvine, CA 92618-1908

Mailing address

9401 Jeronimo Rd
Irvine, CA 92618-1908
Phone (760) 525-2593

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20250711003355 CA Practitioner - Physician Assistant 3375058076 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
66244CAMDRheumatology Physician

Interoperability endpoints

  • Direct secure messaging: kwatkins237774@hpmg.direct-ci.net

Organizations & group practices 1

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": "1573516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741132800000",
    "number": "1780229955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9401 JERONIMO RD",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926181908",
            "telephone_number": "760-525-2593"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9401 JERONIMO RD",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926181908",
            "telephone_number": "760-525-2593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATKINS",
        "first_name": "KAITLYN",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-12",
        "last_updated": "2025-03-05",
        "certification_date": "2025-03-05",
        "deactivation_date": "2025-02-11",
        "reactivation_date": "2025-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

Verify at the official NPI Registry.