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General NPI Number Information
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NPI Number | 1841777190
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Entity Type | Individual
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Provider Name | KATELYN S PONSOLL PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 5535 PEACH ST FL 1
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City | ERIE
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State | PA
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Zip | 16509-2603
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Country | US
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Telephone | 814-868-3488
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Fax | 814-868-3499
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Provider Business Mailing Address
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Address Line | 1 LECOM PL
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City | ERIE
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State | PA
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Zip | 16505-2571
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Country | US
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Telephone | 814-868-2529
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Fax | 814-868-2522
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA059802
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | OA007090
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License Number State | PA
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