Provider Demographics
NPI:1992177604
Name:JAYNE, KELLY ANNE (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:JAYNE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:JAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1016 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603-4525
Mailing Address - Country:US
Mailing Address - Phone:570-802-0102
Mailing Address - Fax:570-802-0104
Practice Address - Street 1:1016 W FRONT ST
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-4525
Practice Address - Country:US
Practice Address - Phone:708-290-0031
Practice Address - Fax:570-802-0104
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2022-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant