Provider Demographics
NPI:1487312682
Name:WIRTH, KAYLYN (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLYN
Middle Name:
Last Name:WIRTH
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 1:305 ASHBURY CT
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-2851
Mailing Address - Country:US
Mailing Address - Phone:724-480-7065
Mailing Address - Fax:
Practice Address - Street 1:490 E NORTH AVE STE 515
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4780
Practice Address - Country:US
Practice Address - Phone:412-681-2300
Practice Address - Fax:412-681-6959
Is Sole Proprietor?:No
Enumeration Date:2021-12-04
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA063221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
15513454OtherCAQH