Provider Demographics
NPI:1699286716
Name:SABO, KAITLYN ANN (PA-C)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ANN
Last Name:SABO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:ANN
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2315 MYRTLE ST STE G30
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-4610
Mailing Address - Country:US
Mailing Address - Phone:814-452-5504
Mailing Address - Fax:814-452-5514
Practice Address - Street 1:2315 MYRTLE ST STE G30
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-4610
Practice Address - Country:US
Practice Address - Phone:814-452-5504
Practice Address - Fax:814-452-5514
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
PAMA059468363A00000X
PAOA004319363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical