Individual provider Active NPI

Katherine Lynn Worsnick, PA-C

  • Medical Physician Assistant
  • Fort Myers, FL
National Provider Identifier
1780873661
Registry record updated Dec 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
9110889 Issued in FL
Practice address
9241 Park Royal Dr
Fort Myers, FL 33908-9204
Phone
(239) 984-9859
NPI assigned
Oct 17, 2007
Last updated
Dec 10, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 9110889 FL Primary

Addresses

Primary practice location

9241 Park Royal Dr
Fort Myers, FL 33908-9204

Mailing address

9241 Park Royal Dr
Fort Myers, FL 33908-9204

Other identifiers 2

IdentifierTypeStateIssuer
P01223433OtherPARR MEDICARE
103205372-0001MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20200824000207 FL Practitioner - Physician Assistant 8820176936 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9110889FLMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Luzerne Wyoming County Mental Health Center #1 Past Accepting new patients
Luzerne Wyoming County Mental Health Center #1 Past Accepting new patients

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733788800000",
    "number": "1780873661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9241 PARK ROYAL DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339089204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9241 PARK ROYAL DR",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339089204",
            "telephone_number": "239-984-9859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WORSNICK",
        "first_name": "KATHERINE",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-17",
        "last_updated": "2024-12-10",
        "certification_date": "2024-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "9110889",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P01223433",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103205372-0001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Myers, FL

Sources for this page

Verify at the official NPI Registry.