Provider Demographics
NPI:1407829963
Name:KALETA, DEBRA MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:MARIE
Last Name:KALETA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:MARIE
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:119 NEVADA DR
Practice Address - Street 2:
Practice Address - City:KULPMONT
Practice Address - State:PA
Practice Address - Zip Code:17834-1960
Practice Address - Country:US
Practice Address - Phone:570-373-1250
Practice Address - Fax:570-373-1718
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA005118363A00000X
PAMA051496363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50053697OtherCAPITAL BLUE CROSS
PA50053697OtherCAPITAL BLUE CROSS
PA077799Medicare PIN