Healthcare Provider Details

I. General information

NPI: 1114729084
Provider Name (Legal Business Name): JOHN MICHAEL KAY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 07/21/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 HOSPITAL DRIVE STE 207
STATE COLLEGE PA
16803-6706
US

IV. Provider business mailing address

PO BOX 206
IRVINGTON VA
22480-0206
US

V. Phone/Fax

Practice location:
  • Phone: 814-235-2480
  • Fax:
Mailing address:
  • Phone: 610-585-8019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
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: