Independent US Healthcare Provider Directory & Public Medical Database
Deactivated NPI 1952396418 Deactivated / Inactive NPI Male Practitioner

Kenneth R Nystrom , PA

Physician Assistant • Patrick Afb, FL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Kenneth Nystrom has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 12, 2005
NPI Deactivation Date April 03, 2024
Total Practice Duration ~19 Years of Practice (2005 – 2024)

Professional Overview & Biography Verified Profile Summary

Kenneth Nystrom, PA was a registered Physician Assistant practicing in Patrick Afb, FL. Throughout an active medical career spanning 19 years, Kenneth Nystrom provided care at the practice location at 1381 S PATRICK DR until profile deactivation on 2024-04-03.

Practice Location & Contact Primary Location

Practice Address

1381 S Patrick Dr

Patrick Afb, FL 329253606

Telephone 3214948237
Fax 3214941378
Associated Practice Facility / Clinic
🏢 45th Medgrp-Patrick Facility NPI 1518941921

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Patrick Afb, FL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 11.1 Yrs
Regional Practice Density
8 Specialists

Practicing in Patrick Afb, FL (10376 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

State License FL PA0003444

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

11 Associated Practitioners
Wade Bravo , PA

Physician Assistant

NPI 1023085255

Physician Assistant

David Farrell , PT

Physical Therapist

NPI 1033104096

Physical Therapist

NPI 1033105986

Doctor of Dental Medicine

Dr. Thomas Hoffman , DO

Preventive Medicine - Occupational Medicine

NPI 1083600399

Doctor of Osteopathic Medicine (D.O.)

Dr. Minal Desai , MD

Internal Medicine

NPI 1093701450

Doctor of Medicine (M.D.)

NPI 1699860593

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated April 03, 2024

Record deactivated on April 03, 2024

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 1381 S PATRICK DR, PATRICK AFB, FL 329253606 (Tel: 3214948237)

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Updated Business Mailing Address July 08, 2007

Registered at 5325 CREEKWOOD DR, MELBOURNE, FL 329401492 (Tel: 3217528134)

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Provider Name / Credentials Updated July 08, 2007

Recorded as KENNETH NYSTROM, PA

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Physician Assistant (License #PA0003444 in FL)

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Initial NPI Registration & Enumeration September 12, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1952396418
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: September 12, 2005
Last Update: July 08, 2007
Deactivation Date: April 03, 2024

Mailing Address

5325 Creekwood Dr

Melbourne, FL 329401492

Phone: 3217528134

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.