Kaitlyn Mikaela Sanders, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

11772 Issued in GA

Practice address

880 SW 145TH Ave Ste 202
Pembroke Pines, FL 33027-6171

Phone

(866) 849-0692

NPI assigned

Sep 7, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Kaitlyn Mikaela Dickerson Former name

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Comprehensive Primary Care, LLC

  • Endocrinology, Diabetes & Metabolism Physician
  • Lawrenceville, GA
  • NPI 1487120820

  GA

  Medicare reassignment
• University of Missouri St. Louis

  • Family Nurse Practitioner
  • Saint Louis, MO
  • NPI 1104047141
  NPD (past)

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

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772064000000",
    "number": "1922555036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3905 JOHNS CREEK COURT COMPREHENSIVE PRIMARY CARE, LLC",
            "address_2": "SUITE 200",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "30024",
            "telephone_number": "678-888-2273",
            "fax_number": "314-516-5988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "880 SW 145TH AVE STE 202",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330276171",
            "telephone_number": "866-849-0692"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "761 Walther Road Comprehensive Primary Care, LLC",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "30046",
            "country_code": "US",
            "telephone_number": "678-888-2273",
            "fax_number": "678-888-2273",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "KAITLYN",
        "middle_name": "MIKAELA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-07",
        "last_updated": "2026-02-26",
        "certification_date": "2026-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "11772",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9120032",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAITLYN",
            "last_name": "DICKERSON",
            "middle_name": "MIKAELA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Milagros Eliana Sanchez
• Mileny Sanchez
• Sally Sanchez
• Selena Sanchez, DMD
• Andrea Beth Sanders, HAS, BC-HIS
• Jose David Sandoval-Sus, M.D.
• Sandra D Farhady Odpa
• Sandra Guerrero,PA
• Avva Saniee
• Racha Sankar, PHD, RD, LD

• All providers in Pembroke Pines, FL
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2026; 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.