MCCULLOUGH, KELLY LOREN (PA-C)

Provider Demographics

• NPI: 1497088025
• Name: MCCULLOUGH, KELLY LOREN (PA-C)
• Entity Type: Individual
• First Name: KELLY
• Middle Name: LOREN
• Last Name: MCCULLOUGH
• Gender: F
• Credentials: PA-C
• Other - First Name: KELLY
• Other - Middle Name: LOREN
• Other - Last Name: HEFFNER
• Other - Last Name Type: Former Name
• Mailing Address - Street 1: 7500 BROOKTREE ROAD
• Mailing Address - Street 2: SUITE 320
• Mailing Address - City: WEXFORD
• Mailing Address - State: PA
• Mailing Address - Zip Code: 15090-5818
• Mailing Address - Country: US
• Mailing Address - Phone: 412-367-0600
• Mailing Address - Fax: 412-367-7079
• Practice Address - Street 1: 9104 BABCOCK BLVD
• Practice Address - Street 2: SUITE 2120
• Practice Address - City: PITTSBURGH
• Practice Address - State: PA
• Practice Address - Zip Code: 15237-5818
• Practice Address - Country: US
• Practice Address - Phone: 412-367-0600
• Practice Address - Fax: 412-367-7079
• Is Sole Proprietor?: No
• Enumeration Date: 2009-09-15
• Last Update Date: 2018-12-19

Provider Licenses

State	License ID	Taxonomies
PA	MA051371	363AM0700X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	363AM0700X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Medical

Provider Identifiers

State	Identifier ID	ID Type	Issuer
	1497088025	Other	AETNA BETTER HEALTH
	1497088025	Other	CORVEL
	1497088025	Other	HIGHMARK MANAGED CARE
	1497088025	Other	UNITED HEALTHCARE/OPTUM
	1497088025	Other	AETNA MEDICARE
	1497088025	Other	DEVON
	1497088025	Other	GEISINGER MEDICARE
	1497088025	Other	KEYSTONE MANAGED CARE
	1497088025	Other	HPUOV
	1497088025	Other	UPMC COMMERCIAL
	1497088025	Other	UNISON OF OH
PA	1497088025	Medicaid
	1490788025	Other	GATEWAY MEDICARE ASSURED
	1497088025	Other	HIGHMARK BLUE SHIELD
	1497088025	Other	FLORA
	1497088025	Other	GATEWAY HEALTH PLAN
	1497088025	Other	GREAT WEST
	1497088025	Other	UNITED HEALTHCARE/UNISON
	1497088025	Other	CIGNA
	1497088025	Other	CIGNA BEHAVIORAL HEALTH
	1497088025	Other	HUMANA COMMERCIAL
	1497088025	Other	MEDICARE-NOVITAS
	1497088025	Other	PRIVATE HEALTH CARE SYSTEM
	1497088025	Other	AETNA COMMERCIAL
	1497088025	Other	GEISINGER HEALTH
	1497088025	Other	INTERGROUP
	1497088025	Other	WEXFORD HEALTH SERVICES
	1497088025	Other	AMERIHEALTH MERCY
	1497088025	Other	FIDELIS CARE MA
	1497088025	Other	COMMUNITY LIFE
	1497088025	Other	FIDELIS CARE MEDICARE
	1497088025	Other	HEALTH AMERICA
	1497088025	Other	PALMETTO--RAILROAD MEDICARE
	1497088025	Other	UNITED HEALTHCARE COMMERCIAL
	1497088025	Other	UPMC FOR LIFE
	1497088025	Other	UPMC FOR YOU
	1497088025	Other	VANTAGE PPO