Provider Demographics
NPI:1043557887
Name:MARTIN, KAYLEIGH MAE (PA)
Entity Type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:MAE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:600 ROE AVENUE
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14905-1676
Mailing Address - Country:US
Mailing Address - Phone:607-737-4508
Mailing Address - Fax:607-735-5738
Practice Address - Street 1:600 ROE AVE
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1629
Practice Address - Country:US
Practice Address - Phone:607-737-4508
Practice Address - Fax:607-735-5738
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016278363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical