Provider Demographics
NPI:1609027309
Name:HIKES, KELLY A (PA)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:A
Last Name:HIKES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:DELANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:785 5TH AVENUE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-217-4217
Practice Address - Street 1:555 N DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2250
Practice Address - Country:US
Practice Address - Phone:717-299-4173
Practice Address - Fax:717-295-4773
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053710363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA25-1716306OtherINTERGROUP
PAMA053710OtherLICENSE
PA25-1716306OtherHEALTH AMERICA/COVENTRY
PA25-1716306OtherPHCS/MULTIPLAN
PA50094829OtherCAPITAL BLUE CROSS
PA6416076OtherAETNA HMO
PA867633OtherMEDICARE GROUP #
PA9762626OtherAETNA NON-HMO
PA9762626OtherAETNA NON-HMO
PA867633OtherMEDICARE GROUP #