MRS. KATHERINE WILEY POINDEXTER (PA-C, RDN) – Dermatology Physician, NPI 1538673058

MRS. KATHERINE WILEY POINDEXTER (PA-C, RDN) is a healthcare provider. based in Jacksonville, Florida. specializing in Dermatology Physician. They hold the professional credentials PA-C, RDN. They hold a License No. LD004401 (GA). The NPI Number for MRS. KATHERINE WILEY POINDEXTER (PA-C, RDN) is 1538673058

Main info

Female
9 Years Of Experience
Accepts Medicare Assignment
Name
MRS. KATHERINE WILEY POINDEXTER (PA-C, RDN)
NPI
1538673058
Phone
(404) 290-1456
Address
1246 Morvenwood Rd
Enumeration Date
20 November 2017
Last Update Date
21 July 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9047279123
Graduation Year
2017 (9 years ago)
PAC ID
8820358468
Group Practice PAC ID
2961452107
Professional Enrollment ID
I20180130003157
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience58
Completeness75
Years active:8State licenses:3Digital endpointsOther names

Provider Addresses for MRS. KATHERINE WILEY POINDEXTER (PA-C, RDN)

  • 1246 Morvenwood Rd

    Jacksonville, FL 322075364

    Phone: (404) 290-1456

    Type: Location

  • 183 Landrum Ln Ste 201

    Ponte Vedra Beach, FL 320823838

    Phone: (904) 567-1050

    Type: Location

  • 2346, Jose Circle South, Jacksonville, Duval County, Florida, 32217, United States

    JACKSONVILLE, FL 322173547

    Phone: (404) 290-1456

    Type: Mailing

  • Saint Johns Bluff Road South, Sandalwood, Jacksonville, Duval County, Florida, 32246-6624, United States

    JACKSONVILLE, FL 322463777

    Phone: (904) 727-9123

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 25 Open Payments records for all available years, with a total value of $604.

Total Amount is formed as General ($604) + Research ($0) + Ownership ($0) = $604.

Last reported payment date: 2024-09-24 • Largest payer in this snapshot: ABBVIE INC. ($276).

Total Amount

$604

General + Research + Ownership

Payments

25

Total payment records

General Amount

$604

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-09-24

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2018-01-30

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20180130003157IPhysician AssistantFLTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
17003Destruction of precancer skin growth, 2-14 growths28456$0
99212Established patient office or other outpatient visit, 10-19 minutes11698$0
17110Destruction of skin growth, 1-14 growths9173$0
17000Destruction of precancer skin growth, 1 growth8876$0
99213Established patient office or other outpatient visit, 20-29 minutes5950$0
View full utilization report →

Insurance plans in this area (ZIP 32207)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2961452107View full group profile
NameSpecialtyState
D E R M A T O L O G YFL
Physician AssistantFL
Physician AssistantFL
Physician AssistantFL

Reviews

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Frequently asked questions

Does MRS. KATHERINE WILEY POINDEXTER (PA-C, RDN) share an NPI with anyone else?
NPI numbers are unique to each provider or organization — MRS. KATHERINE WILEY POINDEXTER (PA-C, RDN) uses 1538673058.
Is MRS. KATHERINE WILEY POINDEXTER (PA-C, RDN) listed as active for patients and plans?
The listing shows MRS. KATHERINE WILEY POINDEXTER (PA-C, RDN) as active in the NPI system.
What taxonomy line describes MRS. KATHERINE WILEY POINDEXTER (PA-C, RDN)?
For research purposes, treat MRS. KATHERINE WILEY POINDEXTER (PA-C, RDN) as Dermatology Physician in this dataset. Clinical services aligned with this taxonomy classification.
Where should I expect MRS. KATHERINE WILEY POINDEXTER (PA-C, RDN) on a map?
Expect Jacksonville, Florida as a primary anchor for MRS. KATHERINE WILEY POINDEXTER (PA-C, RDN) unless the record lists multiple sites.
Why does MRS. KATHERINE WILEY POINDEXTER (PA-C, RDN) have multiple addresses?
4 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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