Provider Demographics
NPI:1538284187
Name:CHILTON-GELFO, AYRYN PAGE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AYRYN
Middle Name:PAGE
Last Name:CHILTON-GELFO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:AYRYN
Other - Middle Name:CHILTON
Other - Last Name:GELFO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4420 DIXIE HWY STE 118
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-2991
Practice Address - Country:US
Practice Address - Phone:502-447-3448
Practice Address - Fax:502-933-4483
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA805363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9500486700Medicaid
KY50018564OtherPASSPORT
KY000000550830OtherANTHEM
KY3502247000OtherPASSPORT ADVANTAGE
KY50018564OtherPASSPORT
FLQ20881Medicare UPIN
KYP00650309Medicare PIN