Katie Lauren Kim, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA.1575 Issued in AL

Practice address

4810 Whitesport Cir SW Ste 110
Huntsville, AL 35801-7439

Phone

(205) 977-9876

NPI assigned

Jun 16, 2020

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

• Katie Kohlenberg Former name

Medicare fee-for-service enrollment

Enrolled in AL

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.

• Aqua Dermatology of Alabama PC

  • MOHS-Micrographic Surgery Physician
  • Vestavia HLS, AL
  • NPI 1477708642
  Medicare reassignment
• Cutaneous Oncology & Surgery Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Vestavia HLS, AL
  • NPI 1699139915
  NPD (past)

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

{
    "created_epoch": "1592265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592265600000",
    "number": "1922624865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1940 STONEGATE DR STE 130",
            "city": "VESTAVIA HLS",
            "state": "AL",
            "postal_code": "352422541",
            "telephone_number": "205-977-9876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4810 WHITESPORT CIR SW STE 110",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358017439",
            "telephone_number": "205-977-9876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIM",
        "first_name": "KATIE",
        "middle_name": "LAUREN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-16",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AL",
            "license": "PA.1575",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATIE",
            "last_name": "KOHLENBERG",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jennifer Pace Kilgore, PHARM D
• Haley Palmer Kilpatrick, PHARMD
• Julie Kilpatrick, RD, LD
• Anna S Kim, M.D.
• David Jiwoong Kim, M.D.
• Sohee Kim, CRNP
• Tonghee Kim, D.C
• Bethany N Kimbril, BT
• R. Denton Kimbrough, D.M.D.
• Justin Nicholas Kimsey, DO

• Surgical Physician Assistant in Huntsville, AL
• Providers in Huntsville, AL by specialty
• Surgical Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.