Provider Demographics
NPI:1295798072
Name:KLINE, ANGELICA M (PA-C)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:M
Last Name:KLINE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:M
Other - Last Name:ZELENSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1800 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6709
Mailing Address - Country:US
Mailing Address - Phone:814-234-6726
Mailing Address - Fax:814-234-1553
Practice Address - Street 1:1800 E PARK AVE
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-6709
Practice Address - Country:US
Practice Address - Phone:814-234-6726
Practice Address - Fax:814-234-1553
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000556L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS59024Medicare UPIN
PA066518Medicare ID - Type UnspecifiedHGSA