Provider Demographics
NPI:1265128409
Name:MCCANN, KAITLIN TAYLOR (PA-C)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:TAYLOR
Last Name:MCCANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:TAYLOR
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:49 N RIDGE AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-4519
Mailing Address - Country:US
Mailing Address - Phone:215-526-7526
Mailing Address - Fax:
Practice Address - Street 1:727 WELSH RD STE 101
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-6357
Practice Address - Country:US
Practice Address - Phone:215-939-4251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-12
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA064474207VG0400X, 363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology