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

Individual provider Physician Assistant · NPI 1912538562

Kathleen Sarah Derr, PA-C is a Physician Assistant in Dayton, Ohio. Qualified in 2019, 7 years ago. Practices with Kettering Independent Medical Group Inc, a 700-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Ohio.

Years since qualifying
7
Licensed in
OH
In the registry since
2020
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

425 W Grand Ave Ste 2002
Dayton, OH 45405-4722
Phone: (937) 425-4144
Fax: (937) 425-4146
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 30 E Apple St Ste 5254, Dayton, OH 45409-2939 — (937) 208-4200

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 50.006351RX (OH)

Record details

NPI number1912538562
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedFebruary 3, 2020
Last updated in NPPESOctober 4, 2022
Certification dateOctober 4, 2022

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Kettering Independent Medical Group Inc — 700 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations3 on file with Medicare

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