KAITLYN SHANE KIMBROUGH PA-C
NPI 1912601733
Physician Assistant in Fort Worth, TX

Q: What is Kaitlyn Kimbrough's NPI number?

The NPI number for Kaitlyn Kimbrough is 1912601733. It was assigned to this individual provider in the NPPES registry on March 27, 2023.

Q: What is Kaitlyn Kimbrough's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Kaitlyn Kimbrough was last updated on February 3, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 months 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.

Active since March 27, 2023PECOS EnrolledAccepts Medicare Assignment

1500 COOPER ST, FORT WORTH, TX 76104(682) 885-2500(682) 885-2510 Get Directions Write a Review

NPPES record last updated: February 3, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Feb 3, 2026, Mar 27, 2023 (2 updates tracked since 2023).

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About Kaitlyn Shane Kimbrough Pa-c NPPES

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

KAITLYN SHANE KIMBROUGH PA-C (NPI 1912601733) is an individual physician assistant in Fort Worth, Texas, licensed in Texas (PA16774) and active in the NPI registry since March 2023. She is enrolled in Medicare PECOS, is affiliated with Methodist Mansfield Medical Center, and is a graduate of Other (2023).

NPPES Registry Identity

NPI1912601733

Entity TypeIndividualFemale

Primary Taxonomy363A00000X

Provider Legal NameKAITLYN SHANE KIMBROUGHCredential: PA-C

Location Address1500 COOPER STFort Worth, TX 76104-2710

Mailing AddressPo Box 733784Dallas, TX 75373-3784 · (682) 885-6483 · Fax (682) 885-3113

Phone(682) 885-2500

Fax(682) 885-2510

Sole ProprietorNo

Medical School CMSOtherGraduated 2023

Enumeration DateMarch 27, 2023

Last NPPES UpdateFebruary 3, 20262 updates tracked since enumeration

NPPES CertifiedFebruary 3, 2026

✔ NPI 1912601733 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in TX · PA16774

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

1500 COOPER ST, Fort Worth, TX 76104

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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of Texas, Imperial Insurance Companies, Inc., Oscar Insurance Company and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Kaitlyn Shane Kimbrough Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID446617161

PECOS Enrollment IDI20230611000230

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.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Removal of gallbladder using an endoscope 47562

This procedure, known as endoscopic gallbladder removal, involves a surgeon using a special tool called an endoscope to remove your gallbladder through small incisions. It's typically done to treat gallstones and related complications. It's a less invasive method, often leading to quicker recovery.

12 services12 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Methodist Mansfield Medical Center

Acute Care Hospitals · Mansfield, TX

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number670023

Location2700 E Broad StreetMansfield, TX 76063 · Tarrant County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 76104 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$87.20 typical visit price

range $56.47 – $171.07

Typical copayment $21.80 (range $14.11 – $42.76)

Most-billed visit code 99203

Established Patient

$70.45 typical visit price

range $18.18 – $139.68

Typical copayment $17.61 (range $4.54 – $34.92)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

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

KATRINA L WILLIE-MUSOMA MD

Pediatrics (Neurodevelopmental Disabilities)