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NPI Code Detail

MEDICARE: KAITLYN STAVELY PA-C

MEDICARE: KAITLYN STAVELY 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 Assistant

General Provider Information

NPI Number : 1447060967
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN STAVELY PA-C
Provider Business Mailing Address
First Line : 301 LIPPINCOTT DR STE 410
Second Line :
City : MARLTON
State : NJ
Zip : 08053-4197
Country : US
Telephone Number : 856-247-7295
Fax Number : 856-247-7118
Provider Business Practice Location Address
First Line : 200 BOWMAN DR STE E366
Second Line :
City : VOORHEES
State : NJ
Zip : 08043-9639
Country : US
Telephone Number : 856-247-7295
Fax Number : 856-247-7118
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/08/2025
Last Update Date : 02/02/2026

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Directions to “ KAITLYN STAVELY PA-C” Practice Location

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