Provider Demographics
NPI:1558885772
Name:LERSCH, KAITLYN S (PA-C)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:S
Last Name:LERSCH
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 1:120 LYTTON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1481
Mailing Address - Country:US
Mailing Address - Phone:412-802-3043
Mailing Address - Fax:
Practice Address - Street 1:120 LYTTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1481
Practice Address - Country:US
Practice Address - Phone:412-802-3043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-30
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059156363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103375597Medicaid