Individual provider Active NPI

Katie Kisner, PA

  • Physician Assistant
  • Morgantown, WV
National Provider Identifier
1811503923
Registry record updated Dec 14, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2395 Issued in WV
Practice address
1005 White Willow Way
Morgantown, WV 26505-6119
Phone
(304) 460-5123
NPI assigned
Sep 23, 2020
Last updated
Dec 14, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 14, 2020

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 2395 WV Primary

Addresses

Primary practice location

1005 White Willow Way
Morgantown, WV 26505-6119

Mailing address

1005 White Willow Way
Morgantown, WV 26505-6119

Other practice location 1

1200 J D Anderson Dr
Morgantown, WV 26505-3494
Phone (304) 598-1200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20201027002395 WV Practitioner - Physician Assistant 7618387929 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Grandw IncGroup PAC ID 9739324922, 93 clinicians

Practice addresses (Care Compare)

1005 White Willow Way
Morgantown, WV 26505-6119
Phone (304) 460-5123

1100 Main St
Suite 104
Wheeling, WV 26003-2737
Phone (304) 460-5123

1200 J D Anderson Dr
Morgantown, WV 26505-3494
Phone (304) 598-1200

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Physician Assistant

State licenses

LicenseStateTypeSpecialty
2395WVMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Monongalia County General Hospital Company Physician Assistant CurrentSince Dec 15, 2020 Accepting new patients
GR&W, Inc CurrentSince Nov 18, 2025 Accepting new patients
Monongalia County General Hospital Company Past Accepting new patients

Locations

1005 White Willow Way
Morgantown, WV 26505
Phone (304) 212-7238

1200 J D Anderson Dr
Morgantown, WV 26505
Phone (304) 598-1460

1100 Main St
Ste 104
Wheeling, WV 26003
Phone (304) 443-1414

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1600819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607904000000",
    "number": "1811503923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 WHITE WILLOW WAY",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265056119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 WHITE WILLOW WAY",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265056119",
            "telephone_number": "304-460-5123"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 J D Anderson Dr",
            "address_purpose": "LOCATION",
            "city": "Morgantown",
            "state": "WV",
            "postal_code": "265053494",
            "country_code": "US",
            "telephone_number": "304-598-1200",
            "fax_number": "304-598-1699",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KISNER",
        "first_name": "KATIE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-23",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "2395",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morgantown, WV

Sources for this page

Verify at the official NPI Registry.