Individual provider Active NPI

Kaitlyn Megan Console, PA-C

  • Physician Assistant
  • Placerville, CA
National Provider Identifier
1811851074
Registry record updated Mar 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA65553 Issued in CA
Practice address
4212 Missouri Flat Rd
Placerville, CA 95667-6269
Phone
(530) 621-7700
Fax
(530) 621-7713
NPI assigned
Dec 12, 2025
Last updated
Mar 2, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2026

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 PA65553 CA Primary

Addresses

Primary practice location

4212 Missouri Flat Rd
Placerville, CA 95667-6269

Mailing address

4212 Missouri Flat Rd
Placerville, CA 95667-6269
Phone (530) 621-7700

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
I20260313001439 CA Order and Referring Only - Physician Assistant 0547743924

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PA65553CAMDPhysician Assistant

NPI Registry JSON

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

{
    "created_epoch": "1765497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772409600000",
    "number": "1811851074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4212 MISSOURI FLAT RD",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956676269",
            "telephone_number": "530-621-7700",
            "fax_number": "530-621-7713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 MISSOURI FLAT RD",
            "city": "PLACERVILLE",
            "state": "CA",
            "postal_code": "956676269",
            "telephone_number": "530-621-7700",
            "fax_number": "530-621-7713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONSOLE",
        "first_name": "KAITLYN",
        "middle_name": "MEGAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-12-12",
        "last_updated": "2026-03-02",
        "certification_date": "2026-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA65553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Placerville, CA

Sources for this page

Verify at the official NPI Registry.