MEDICARE: KAITLYN A DOOLEY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	OA006114	PA
2	363A00000X	Physician Assistant	MA063615	PA
3	363A00000X	Physician Assistant	50.009608RX	OH

General Provider Information

NPI Number	:	1306575998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN A DOOLEY PA-C

Provider Business Mailing Address
First Line	:	6780 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-2203
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6780 MAYFIELD RD
Second Line	:
City	:	MAYFIELD HEIGHTS
State	:	OH
Zip	:	44124-2203
Country	:	US
Telephone Number	:	440-312-4500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2022
Last Update Date	:	01/05/2026

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