Provider Demographics
NPI:1700818937
Name:JANICK, KATHRYN (PA C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:JANICK
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:
Other - Last Name:JANICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:130 S 9TH ST
Mailing Address - Street 2:6TH FLOOR EDISON
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5233
Mailing Address - Country:US
Mailing Address - Phone:215-503-0137
Mailing Address - Fax:
Practice Address - Street 1:130 S 9TH ST
Practice Address - Street 2:6TH FLOOR EDISON
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5233
Practice Address - Country:US
Practice Address - Phone:215-503-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant