Provider Demographics
NPI:1942731963
Name:HUMMER, KAITLYN M (PA)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:M
Last Name:HUMMER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2109 HUGHES DR STE 220
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-5121
Mailing Address - Country:US
Mailing Address - Phone:419-291-5150
Mailing Address - Fax:419-479-6173
Practice Address - Street 1:2109 HUGHES DR STE 220
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-5121
Practice Address - Country:US
Practice Address - Phone:419-291-5150
Practice Address - Fax:419-479-6173
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50005055RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant