NPIMap

Individual provider Active NPI

Katie Bloxton

  • Medical Physician Assistant
  • South Charleston, WV
National Provider Identifier
1891108502
Registry record updated Apr 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1119180 Issued in WV
Practice address
4202 Maccorkle Ave SW Ste 200
South Charleston, WV 25309-1513
Phone
(304) 925-7546
Fax
(681) 205-8369
NPI assigned
Jun 10, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 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 1119180 WV Primary

Addresses

Primary practice location

4202 Maccorkle Ave SW Ste 200
South Charleston, WV 25309-1513

Mailing address

4202 Maccorkle Ave SW Ste 200
South Charleston, WV 25309-1513
Phone (304) 925-7546

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
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
I20180205002826 WV Practitioner - Physician Assistant 0648530907 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Virginia Dermatology and Skin Surgery CenterGroup PAC ID 7214183136, 6 clinicians

Practice addresses (Care Compare)

4202 Maccorkle Ave SW
Suite 200
S Charleston, WV 25309-1320
Phone (304) 925-7546

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.72 of 100Reported as individual
Quality
79.43
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1119180WVMDMedical Physician Assistant

Organizations & group practices 1

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 11

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": "1402358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775433600000",
    "number": "1891108502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4202 MACCORKLE AVE SW STE 200",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091513",
            "telephone_number": "304-925-7546",
            "fax_number": "681-205-8369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4202 MACCORKLE AVE SW STE 200",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253091513",
            "telephone_number": "304-925-7546",
            "fax_number": "681-205-8369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLOXTON",
        "first_name": "KATIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-10",
        "last_updated": "2026-04-06",
        "certification_date": "2026-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WV",
            "license": "1119180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

Verify at the official NPI Registry.