MEDICARE: KATIE FLUHARTY 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	25MP0039000	NJ

General Provider Information

NPI Number	:	1699137398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATIE FLUHARTY PA-C

Provider Business Mailing Address
First Line	:	6410 NEW JERSEY AVE
Second Line	:
City	:	WILDWOOD CREST
State	:	NJ
Zip	:	08260-1216
Country	:	US
Telephone Number	:	609-523-1331
Fax Number	:	609-569-7070

Provider Business Practice Location Address
First Line	:	6410 NEW JERSEY AVE
Second Line	:
City	:	WILDWOOD CREST
State	:	NJ
Zip	:	08260-1216
Country	:	US
Telephone Number	:	609-523-1331
Fax Number	:

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

Provider Enumeration Date	:	03/22/2016
Last Update Date	:	01/09/2024

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