NPIMap

Individual provider Active NPI

Kyla Marshall, PA-C

  • Physician Assistant
  • Sonora, CA
National Provider Identifier
1881430569
Registry record updated Nov 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA67219 Issued in CA
Practice address
1000 Greenley Rd
Sonora, CA 95370-5200
Phone
(209) 536-5000
NPI assigned
Jul 2, 2024
Last updated
Nov 12, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2025

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 PA67219 CA Primary

Addresses

Primary practice location

1000 Greenley Rd
Sonora, CA 95370-5200

Mailing address

83 S Stewart St Ste 202
Sonora, CA 95370-4771

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251210004195 CA Practitioner - Physician Assistant 2163916735 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

14540 Mono Way
Sonora, CA 95370-8858
Phone (209) 536-6680

23 N Main St
Suite 101
Angels Camp, CA 95222-8001
Phone (209) 736-9130

729 Pauline Court
Sonora, CA 95370
Phone (209) 588-8068

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA67219CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Physicians Network CurrentSince Oct 4, 2025 Accepting new patients
Adventist Health Physicians Network CurrentSince Oct 4, 2025 Accepting new patients
Adventist Health Heart Institute-Ukiah Past Accepting new patients

Locations

23 N Main St
#101
Angels Camp, CA 95222
Phone (209) 736-9130

14540 State Highway 108
Sonora, CA 95370
Phone (209) 532-3167

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 12

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": "1719878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762905600000",
    "number": "1881430569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "83 S STEWART ST STE 202",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953704771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 GREENLEY RD",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705200",
            "telephone_number": "209-536-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "KYLA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-02",
        "last_updated": "2025-11-12",
        "certification_date": "2025-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA67219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sonora, CA

Sources for this page

Verify at the official NPI Registry.