Kara Jean Knickerbocker, D.O.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

34.013579 Issued in OH

Practice address

4881 Sugar Maple Dr
Wright Patterson Afb, OH 45433-5529

Phone

(937) 257-6991

NPI assigned

Apr 12, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Kara Jean Dickey Former name

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1491955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608163200000",
    "number": "1871027243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13704 MIDDLETON PIKE",
            "city": "BOWLING GREEN",
            "state": "OH",
            "postal_code": "434029480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WRIGHT PATTERSON AFB",
            "state": "OH",
            "postal_code": "454335529",
            "telephone_number": "937-257-6991"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Childrens Plz",
            "address_purpose": "LOCATION",
            "city": "Dayton",
            "state": "OH",
            "postal_code": "454041873",
            "country_code": "US",
            "telephone_number": "937-641-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KNICKERBOCKER",
        "first_name": "KARA",
        "middle_name": "JEAN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-12",
        "last_updated": "2020-12-17",
        "certification_date": "2020-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "34.013579",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KARA",
            "last_name": "DICKEY",
            "middle_name": "JEAN",
            "prefix": "DR.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Devin Christopher Kelly, DO
• Nikole Marie Kerns
• Richard Kirkman
• Aria Klein, CRNA
• Joseph Kluesner, M.D.
• Beverley Sue Knight-Stukenborg
• Nancy J Koets, PSYD
• Matthew Thomas Koroscil, M.D.
• Alex Daniel Krehbiel
• Andrea Elaine Krunnfusz, PHD

• Pediatrics Physician in Wright Patterson Afb, OH
• Providers in Wright Patterson Afb, OH by specialty
• Pediatrics Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.