Provider Demographics
NPI:1962193987
Name:WHALEN, KILEY C (PA)
Entity type:Individual
Prefix:MS
First Name:KILEY
Middle Name:C
Last Name:WHALEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:16 AMETHYST DR
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-9498
Mailing Address - Country:US
Mailing Address - Phone:518-744-3241
Mailing Address - Fax:
Practice Address - Street 1:17 MAIN ST
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-4007
Practice Address - Country:US
Practice Address - Phone:518-798-0767
Practice Address - Fax:518-798-0815
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant