Provider Demographics
NPI:1164119574
Name:KOSTICK, SKYLAR MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:SKYLAR
Middle Name:MARIE
Last Name:KOSTICK
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 1:108 CHESWOLD CT
Mailing Address - Street 2:
Mailing Address - City:CHESTERBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19087-5628
Mailing Address - Country:US
Mailing Address - Phone:610-849-3082
Mailing Address - Fax:
Practice Address - Street 1:7150 HAMILTON BLVD UNIT 400
Practice Address - Street 2:
Practice Address - City:TREXLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18087-9734
Practice Address - Country:US
Practice Address - Phone:610-849-3082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA006465363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical