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

Individual provider Physician Assistant · NPI 1043876170

Mary Alice Disselkamp, PA-C is a Physician Assistant in Elizabethtown, Kentucky. Qualified in 2019, 7 years ago. Practices with Radiology Associates Inc, a 57-clinician group and accepts Medicare assignment. Licensed in Kentucky.

Years since qualifying
7
Licensed in
KY
In the registry since
2019
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

2407 Ring Rd Ste 108
Elizabethtown, KY 42701-5938
Phone: (270) 706-5787
Fax: (270) 706-5788
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X (KY)

Record details

NPI number1043876170
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMay 14, 2019
Last updated in NPPESNovember 8, 2023
Certification dateNovember 8, 2023

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 Radiology Associates Inc — 57 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Elizabethtown