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MIKAYLA VAN GORDER PA
NPI 1326705633
Physician Assistant - Medical in Fulton, NY

Active since November 22, 2021PECOS Enrolled
510 S 4TH ST STE 600, FULTON, NY 13069(315) 598-4790(315) 593-6195 Get Directions Write a Review

NPPES record last updated: May 6, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: May 6, 2024, Feb 5, 2024, Nov 22, 2021 (3 updates tracked since 2021).

About Mikayla Van Gorder Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MIKAYLA VAN GORDER PA (NPI 1326705633) is an individual medical provider in Fulton, New York, licensed in New York (027732) and active in the NPI registry since November 2021. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1326705633
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameMIKAYLA VAN GORDERCredential: PA
Location Address510 S 4TH ST STE 600Fulton, NY 13069-2952
Mailing Address61 Delano StPulaski, NY 13142-1400 · (315) 298-6569
Phone(315) 598-4790
Fax(315) 593-6195
Sole ProprietorNo
Enumeration DateNovember 22, 2021
Last NPPES UpdateMay 6, 20243 updates tracked since enumeration
NPPES CertifiedMay 6, 2024
✔ NPI 1326705633 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in NY · 027732
510 S 4TH ST STE 600, Fulton, NY 13069
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Other Names 1

Former Name (1)Mikayla Fox Pa

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mikayla Van Gorder Pa is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TRAVIS COWART LMHC
Counselor (Mental Health)
510 S 4TH ST STE 600
FULTON, NY 13069
Oswego County (315) 598-4790
ANTHONY BRYANT PMHNP
Nurse Practitioner (Psychiatric/Mental Health)
510 S 4TH ST STE 600
FULTON, NY 13069
Oswego County (315) 598-4790
TAYLOR ELIZABETH YOUNG PA
Physician Assistant (Medical)
510 S 4TH ST STE 600
FULTON, NY 13069
Oswego County (315) 598-4790
MICHAEL MILLER MD
Family Medicine
510 S 4TH ST STE 600
FULTON, NY 13069
Oswego County (315) 598-4790
FAITH SLADE FNP-C
Nurse Practitioner (Family)
510 S 4TH ST STE 600
FULTON, NY 13069
Oswego County (315) 598-4790

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mikayla Van Gorder's NPI number?

The NPI number for Mikayla Van Gorder is 1326705633. It was assigned to this individual provider in the NPPES registry on November 22, 2021. The provider is also known as Mikayla Fox PA.

Where is Mikayla Van Gorder located?

Mikayla Van Gorder practices at 510 S 4th St Ste 600, Fulton, NY 13069. The listed phone number is (315) 598-4790.

What is Mikayla Van Gorder's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Mikayla Van Gorder enrolled in Medicare?

Yes. Mikayla Van Gorder is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Mikayla Van Gorder was last updated on May 6, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.