Provider Demographics
NPI:1386283083
Name:REICHARD, KAITLYN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:
Last Name:REICHARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7788 LINCOLN ST SE
Mailing Address - Street 2:
Mailing Address - City:EAST CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44730-9461
Mailing Address - Country:US
Mailing Address - Phone:330-488-5170
Mailing Address - Fax:
Practice Address - Street 1:141 N FORGE ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1407
Practice Address - Country:US
Practice Address - Phone:330-375-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-27
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.006054RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant