Provider Demographics
NPI:1518513837
Name:STALBIRD, KATELYN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KATELYN
Middle Name:
Last Name:STALBIRD
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 1:1341 OSMOND RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7148
Mailing Address - Country:US
Mailing Address - Phone:410-703-8086
Mailing Address - Fax:
Practice Address - Street 1:612 SEACOAST PKWY
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8247
Practice Address - Country:US
Practice Address - Phone:843-881-4440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC363A00000X
SC3612363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant