Healthcare Provider Details

I. General information

NPI: 1972348126
Provider Name (Legal Business Name): KELSEY VUKIC PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 CENTRE AVE STE 209
PITTSBURGH PA
15232-1312
US

IV. Provider business mailing address

507 WALNUT GRV
CRANBERRY TOWNSHIP PA
16066-2847
US

V. Phone/Fax

Practice location:
  • Phone: 412-605-3019
  • Fax:
Mailing address:
  • Phone: 724-766-0127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA065549
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: