Provider Demographics
NPI:1730105271
Name:KADRYNA, NIKKI LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:LYNN
Last Name:KADRYNA
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 1:1 HOSPITAL DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9350
Mailing Address - Country:US
Mailing Address - Phone:570-522-4110
Mailing Address - Fax:570-768-3911
Practice Address - Street 1:935 ROUTE 522
Practice Address - Street 2:
Practice Address - City:SELINSGROVE
Practice Address - State:PA
Practice Address - Zip Code:17870-9714
Practice Address - Country:US
Practice Address - Phone:570-372-6102
Practice Address - Fax:570-372-6110
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA003137L363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA970010842OtherRAILROAD MEDICARE
PA50041804OtherCAPITAL BLUE CROSS
PA970010842OtherRAILROAD MEDICARE