Individual provider Active NPI

Katelyn Raulerson, APRN

  • Family Nurse Practitioner
  • St Augustine, FL
National Provider Identifier
1902467095
Registry record updated Jun 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
APRN9383310 Issued in FL
Practice address
130 Health Park Blvd
St Augustine, FL 32086-5776
Phone
(904) 826-3469
Fax
(904) 826-4423
NPI assigned
Jun 28, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN9383310 FL Primary

Addresses

Primary practice location

130 Health Park Blvd
St Augustine, FL 32086-5776

Mailing address

130 Health Park Blvd
St Augustine, FL 32086-5776
Phone (904) 826-3469

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190731002220 FL Practitioner - Nurse Practitioner 5092041830 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN9383310FLMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Flagler Family Medicine P a CurrentSince Jul 2, 2019 Accepting new patients
Flagler Family Medicine PA CurrentSince Jul 2, 2019 Accepting new patients
Flagler Family Nursing Home Care LLC CurrentSince May 1, 2021 Accepting new patients

Locations

130 Health Park Blvd
St Augustine, FL 32086
Phone (904) 826-3469

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/ADBCAA

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1561680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561680000000",
    "number": "1902467095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 HEALTH PARK BLVD",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865776",
            "telephone_number": "904-826-3469",
            "fax_number": "904-826-4423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 HEALTH PARK BLVD",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865776",
            "telephone_number": "904-826-3469",
            "fax_number": "904-826-4423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAULERSON",
        "first_name": "KATELYN",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-28",
        "last_updated": "2019-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN9383310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Augustine, FL

Sources for this page

Verify at the official NPI Registry.