Provider Demographics
NPI:1598118655
Name:VINESKY, KALEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:KALEIGH
Middle Name:
Last Name:VINESKY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KALEIGH
Other - Middle Name:
Other - Last Name:HUBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 PEACH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1423
Mailing Address - Country:US
Mailing Address - Phone:814-459-1851
Mailing Address - Fax:814-456-0541
Practice Address - Street 1:100 PEACH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507
Practice Address - Country:US
Practice Address - Phone:814-459-1851
Practice Address - Fax:814-456-0541
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058254363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant