Healthcare Provider Details

I. General information

NPI: 1871934018
Provider Name (Legal Business Name): KIMBERLY ANN KAVANAGH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 SPRING ST
LOCK HAVEN PA
17745-1911
US

IV. Provider business mailing address

100 N ACADEMY AVE
DANVILLE PA
17822-9800
US

V. Phone/Fax

Practice location:
  • Phone: 570-263-5840
  • Fax: 570-893-6325
Mailing address:
  • Phone: 570-263-5840
  • Fax: 570-893-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberOA003060
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA056146
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: