NPIMap

Individual provider Active NPI

Kathryn Everhart Boden, PA-C

  • Medical Physician Assistant
  • Fayetteville, NC
National Provider Identifier
1962611384
Registry record updated May 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
4401 Ramsey Street, Fast Med Urgent Care
Suite 104
Fayetteville, NC 28311
Phone
(910) 354-3372
Fax
(910) 491-5813
NPI assigned
May 22, 2007
Last updated
May 25, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 25, 2021

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 NU Primary

Addresses

Primary practice location

4401 Ramsey Street, Fast Med Urgent Care
Suite 104
Fayetteville, NC 28311

Mailing address

966 Pepperwood Drive
Fayetteville, NC 28311
Phone (919) 817-7811

Other identifiers 1

IdentifierTypeStateIssuer
101227OtherNCLICENSE NUMBER

Other names 1

  • Kathryn Everhart Newell Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20090302000322 NC Practitioner - Physician Assistant 5890851711 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Goshen Medical Center Incorporated CurrentSince Jul 22, 2019 Accepting new patients
Goshen Medical Center Incorporated CurrentSince Jul 22, 2019 Accepting new patients
Bladen Healthcare LLC CurrentSince Nov 1, 2018 Accepting new patients
Raleigh Durham Medical Group PA Past Accepting new patients
Urgent Cares of America NC Inc PastSince Jun 22, 2021 Accepting new patients
Bladen Healthcare LLC Past Accepting new patients

Locations

501 S Poplar St
Elizabethtown, NC 28337
Phone (910) 862-4043

444 SW Center St
Faison, NC 28341
Phone (910) 267-0421

Interoperability endpoints

  • Direct secure messaging: knewell16318@capefearvalley.direct-ci.com

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621900800000",
    "number": "1962611384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "966 PEPPERWOOD DRIVE",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "28311",
            "telephone_number": "919-817-7811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4401 RAMSEY STREET, FAST MED URGENT CARE",
            "address_2": "SUITE 104",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "28311",
            "telephone_number": "910-354-3372",
            "fax_number": "910-491-5813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODEN",
        "first_name": "KATHRYN",
        "middle_name": "EVERHART",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-22",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "101227",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHRYN",
            "last_name": "NEWELL",
            "middle_name": "EVERHART",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.