Healthcare Provider Details

I. General information

NPI: 1346960580
Provider Name (Legal Business Name): KAITLYN FISCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 06/20/2024
Certification Date: 06/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 LONGFELLOW ST STE 200
VANDERGRIFT PA
15690-1476
US

IV. Provider business mailing address

224 LONGFELLOW ST STE 200
VANDERGRIFT PA
15690-1476
US

V. Phone/Fax

Practice location:
  • Phone: 724-568-5551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician 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: