Provider Demographics
NPI:1659815884
Name:ALTIZER, KAITLYN CASTAGNA (PA)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:CASTAGNA
Last Name:ALTIZER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:TONYA
Other - Middle Name:KAITLYN
Other - Last Name:CASTAGNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1015 SPRING CREEK PKWY
Practice Address - Street 2:
Practice Address - City:ZION CROSSROADS
Practice Address - State:VA
Practice Address - Zip Code:22942-7019
Practice Address - Country:US
Practice Address - Phone:434-243-9466
Practice Address - Fax:434-243-9499
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005626207Q00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine