Provider Demographics
NPI:1386112514
Name:PALETTA, KAITLYN RENAE (PA-C)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:RENAE
Last Name:PALETTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:RENAE
Other - Last Name:MCCAFFERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1 HOSPITAL DR STE 306
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-2990
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9350
Practice Address - Country:US
Practice Address - Phone:570-522-4264
Practice Address - Fax:570-768-3709
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA004696363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103591626Medicaid
PAP02202132OtherRR MEDICARE
PA750658OtherMEDICARE