Provider Demographics
NPI:1891163580
Name:SIZEMORE, KAITLYN E (PA-C)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:E
Last Name:SIZEMORE
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 1:450B WASHINGTON JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-7600
Mailing Address - Country:US
Mailing Address - Phone:937-456-8360
Mailing Address - Fax:866-585-5451
Practice Address - Street 1:450B WASHINGTON JACKSON RD
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-7600
Practice Address - Country:US
Practice Address - Phone:937-456-8360
Practice Address - Fax:866-585-5451
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-11
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.004467363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0144994Medicaid