Provider Demographics
NPI:1366851016
Name:HEAD, KATELYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATELYNN
Middle Name:
Last Name:HEAD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATELYNN
Other - Middle Name:
Other - Last Name:DILENDIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-884-0469
Mailing Address - Fax:484-884-0628
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-5369
Practice Address - Fax:610-402-5959
Is Sole Proprietor?:No
Enumeration Date:2014-08-07
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA056864363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical