Provider Demographics
NPI:1992055313
Name:HELLYER, KAITLIN K (PA-C)
Entity type:Individual
Prefix:MS
First Name:KAITLIN
Middle Name:K
Last Name:HELLYER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:A
Other - Last Name:KILLIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2005 TECHNOLOGY PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9413
Mailing Address - Country:US
Mailing Address - Phone:717-988-5864
Mailing Address - Fax:717-221-5615
Practice Address - Street 1:2005 TECHNOLOGY PKWY STE 300
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9413
Practice Address - Country:US
Practice Address - Phone:717-988-5864
Practice Address - Fax:717-221-5615
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055655363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103166292Medicaid
PA313204Medicare PIN