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NPI Code Detail

MEDICARE: KAITLYN ELAINE RUSSO PA-C

MEDICARE: KAITLYN ELAINE RUSSO PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantMA067750PA

General Provider Information

NPI Number : 1205773850
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN ELAINE RUSSO PA-C
Provider Business Mailing Address
First Line : 500 UNIVERSITY DR MC CA410
Second Line :
City : HERSHEY
State : PA
Zip : 17033-2360
Country : US
Telephone Number : 717-531-5208
Fax Number : 717-531-0119
Provider Business Practice Location Address
First Line : 500 UNIVERSITY DR
Second Line :
City : HERSHEY
State : PA
Zip : 17033-2360
Country : US
Telephone Number : 717-531-8955
Fax Number : 717-531-4587
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2026
Last Update Date : 06/09/2026

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Directions to “ KAITLYN ELAINE RUSSO PA-C” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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