Provider Demographics
NPI:1184115925
Name:HOSTETLER, KATLYN MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:MARIE
Last Name:HOSTETLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KATLYN
Other - Middle Name:MARIE
Other - Last Name:PUSKAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:247 MOREWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1861
Mailing Address - Country:US
Mailing Address - Phone:412-622-0290
Mailing Address - Fax:
Practice Address - Street 1:314 S KIMBERLY AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2223
Practice Address - Country:US
Practice Address - Phone:814-443-8266
Practice Address - Fax:814-443-8261
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059820363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical