Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Kenneth Nicholas Halter II, PA-C

Individual provider Physician Assistant · NPI 1053745059

Mr. Kenneth Nicholas Halter II, PA-C is a Physician Assistant in LA Jolla, California. Qualified in 2012, 14 years ago. Practices with Regents of the University of California, a 2,061-clinician group, accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
14
Licensed in
CA
In the registry since
2013
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

9350 Campus Point Dr
LA Jolla, CA 92037-1300
Phone: (858) 657-6035
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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 PA22613 (CA)

Record details

NPI number1053745059
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorYes
NPI enumeratedAugust 26, 2013
Last updated in NPPESSeptember 20, 2017

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Group practice Regents Of The University Of California — 2061 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations5 on file with Medicare

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