Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Katelyn Khemmoro, PA-C

Individual provider Physician Assistant · NPI 1720869118

Katelyn Khemmoro, PA-C is a Physician Assistant in Warren, Michigan. Qualified in 2023, 3 years ago. Practices with Michigan Surgery Specialists PC, a 27-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
3
Licensed in
MI
In the registry since
2023
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

11012 E 13 Mile Rd Ste 112
Warren, MI 48093-2546
Phone: (586) 573-6880
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601012088 (MI)

Record details

NPI number1720869118
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedOctober 11, 2023
Last updated in NPPESFebruary 20, 2026
Certification dateFebruary 20, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Group practice Michigan Surgery Specialists Pc — 27 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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