Provider Demographics
NPI:1063817039
Name:SIMCOE, KALEIGH NICOLE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:KALEIGH
Middle Name:NICOLE
Last Name:SIMCOE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2905
Mailing Address - Country:US
Mailing Address - Phone:814-333-5736
Mailing Address - Fax:
Practice Address - Street 1:1015 GROVE ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2905
Practice Address - Country:US
Practice Address - Phone:814-333-5736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057231363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical