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

Individual provider Physician Assistant · NPI 1053031526

Kathryn Louise Nickerson, PA-C is a Physician Assistant in Winston Salem, North Carolina. Qualified in 2022, 4 years ago. Practices with Novant Health Medical Group, LLC, a 2,410-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
4
Licensed in
NC
In the registry since
2022
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

114 Charlois Blvd
Winston Salem, NC 27103-1522
Phone: (336) 765-5470
Fax: (336) 499-5428
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 450 Brookline Ave, Boston, MA 02215-5450 — (617) 632-3000

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-15673 (NC)

Record details

NPI number1053031526
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 2, 2022
Last updated in NPPESOctober 29, 2025
Certification dateOctober 29, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Novant Health Medical Group, Llc — 2410 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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