Provider Demographics
NPI:1427782960
Name:ZOPPETTI, KELSIE CAILYN (PA-C)
Entity type:Individual
Prefix:
First Name:KELSIE
Middle Name:CAILYN
Last Name:ZOPPETTI
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 1:737 WELDON ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1608
Mailing Address - Country:US
Mailing Address - Phone:724-972-8973
Mailing Address - Fax:
Practice Address - Street 1:5706 GLADES PIKE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-8302
Practice Address - Country:US
Practice Address - Phone:814-445-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA006126363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant