Healthcare Provider Details

I. General information

NPI: 1912571084
Provider Name (Legal Business Name): SUSAN ALEXANDRA KICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2021
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6406 LINDSEY LN
EXPORT PA
15632-2569
US

IV. Provider business mailing address

6406 LINDSEY LN
EXPORT PA
15632-2569
US

V. Phone/Fax

Practice location:
  • Phone: 412-651-5981
  • Fax:
Mailing address:
  • Phone: 412-651-5981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: