Active NPI
Kellie Renee' Longenecker, PA-C
- Physician Assistant
- Arcadia, FL
National Provider Identifier
1851541593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA9104809
- Practice address
- 901 N Waldron St.
Arcadia, FL 34266-5011 - Phone
- (863) 303-4260
- Fax
- (863) 494-3227
- NPI assigned
- Sep 30, 2008
- Last updated
- Oct 4, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA9104809 | FL | Primary |
Addresses
Primary practice location
901 N Waldron St.
Arcadia, FL 34266-5011
Mailing address
901 N Waldron St
Arcadia, FL 34266-3541
Phone (863) 303-4260
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kinmed, P.a. | Physician Assistant | Current | Accepting new patients |
| Alta Health Group LLC | Past | Accepting new patients |
Locations
19910 S Tamiami Trl
Ste C
Estero, FL 33928
Phone (239) 948-1222
Interoperability endpoints
- https://api.platform.athenahealth.com/18228/brand/1/csg/1/fhir/r4
Organizations & group practices 2
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.
-
- Family Medicine Physician
- Naples, FL
- NPI 1700133303
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1222732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633305600000",
"number": "1851541593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 N WALDRON ST",
"city": "ARCADIA",
"state": "FL",
"postal_code": "342663541",
"telephone_number": "863-303-4260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 N WALDRON ST.",
"city": "ARCADIA",
"state": "FL",
"postal_code": "342665011",
"telephone_number": "863-303-4260",
"fax_number": "863-494-3227"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LONGENECKER",
"first_name": "KELLIE",
"middle_name": "RENEE'",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-30",
"last_updated": "2021-10-04",
"certification_date": "2021-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "FL",
"license": "PA9104809",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Arcadia, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.