Individual provider Active NPI

Katelyn Ann Ignacio Bautista, PA-C

  • Medical Physician Assistant
  • New York, NY
National Provider Identifier
1861306706
Registry record updated Sep 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
215 E 95TH St Ste I
New York, NY 10128-4077
Phone
(718) 732-4049
NPI assigned
Sep 29, 2026
Last updated
Sep 29, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2026

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 NU Primary

Addresses

Primary practice location

215 E 95TH St Ste I
New York, NY 10128-4077

Mailing address

60 E 34TH St Apt 4F
New York, NY 10016-4331
Phone (818) 653-6353

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI Registry JSON

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

{
    "created_epoch": "1790640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1861306706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 E 34TH ST APT 4F",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100164331",
            "telephone_number": "818-653-6353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 E 95TH ST STE I",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101284077",
            "telephone_number": "718-732-4049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "KATELYN ANN",
        "middle_name": "IGNACIO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-09-29",
        "last_updated": "2026-09-29",
        "certification_date": "2026-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.