Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

MS. Desiree Ettalee Van Dyne, PA

Individual provider Physician Assistant · NPI 1528343613

MS. Desiree Ettalee Van Dyne, PA is a Physician Assistant in Columbus, Ohio. Qualified in 2011, 15 years ago. Practices with Ohiohealth Corporation, a 2,289-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Kentucky and Ohio.

Years since qualifying
15
Licensed in
KY, OH
In the registry since
2011
Specialties on file
3
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

3535 Olentangy River Rd
Columbus, OH 43214-3998
Phone: (614) 566-5000
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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 50.003418RX (OH)
Physician Assistant Taxonomy 363A00000X · Licence TC224 (KY)
Physician Assistant Taxonomy 363A00000X · Licence PA3049 (KY)

Record details

NPI number1528343613
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedOctober 20, 2011
Last updated in NPPESOctober 2, 2023
Certification dateOctober 2, 2023

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Ohiohealth Corporation — 2289 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations7 on file with Medicare

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