NPIMap

Individual provider Active NPI

Kaitlyn Rose Hickey, PA

  • Physician Assistant
  • Columbia, SC
National Provider Identifier
1801694914
Registry record updated Jul 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5881 Issued in SC
Practice address
2 Medical Park Rd Ste 104
Columbia, SC 29203-6839
Phone
(803) 296-7864
Fax
(803) 296-9699
NPI assigned
Mar 4, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X
Physician Assistant 363A00000X 5881 SC Primary

Addresses

Primary practice location

2 Medical Park Rd Ste 104
Columbia, SC 29203-6839

Mailing address

300 E McBee Ave Ste 300
Greenville, SC 29601-2899
Phone (864) 522-8611

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250722000420 SC Practitioner - Physician Assistant 4486160926 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prisma Health Medical Group-MidlandsGroup PAC ID 5991099707, 1,040 clinicians

Practice addresses (Care Compare)

104 Saluda Pointe Dr
Lexington, SC 29072-7295
Phone (803) 296-7846

14 Richland Medical Park Dr
Suite 200
Columbia, SC 29203-6882
Phone (803) 296-7846

2 Medical Park Rd
Columbia, SC 29203-6839

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5881SCMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health Medical Group-Midlands CurrentSince Jul 21, 2025 Accepting new patients
Prisma Health Medical Group-Midlands CurrentSince Jul 21, 2025 Accepting new patients
Prisma Health Medical Group-Midlands Past Accepting new patients

Locations

14 Richland Medical Park Dr
Ste 200
Columbia, SC 29203
Phone (803) 296-9200

1120 Roberts Branch Pkwy
Ste 200
Columbia, SC 29203
Phone (803) 296-9206

2 Medical Park Rd
Ste 104
Columbia, SC 29203
Phone (803) 434-6781

300 Palmetto Health Pkwy
Ste 200
Columbia, SC 29212
Phone (803) 434-4790

100 Palmetto Health Pkwy
Ste 320
Columbia, SC 29212
Phone (803) 296-9200

104 Saluda Pointe Dr
Lexington, SC 29072
Phone (803) 296-9200

Interoperability endpoints

  • Direct secure messaging: khickey763654@direct.ghs.myhfn.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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1741046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1801694914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE STE 300",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012899",
            "telephone_number": "864-522-8611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 MEDICAL PARK RD STE 104",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036839",
            "telephone_number": "803-296-7864",
            "fax_number": "803-296-9699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKEY",
        "first_name": "KAITLYN",
        "middle_name": "ROSE",
        "name_prefix": "Ms.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-03-04",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "5881",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, SC

Sources for this page

Verify at the official NPI Registry.