Provider Demographics
NPI:1720489222
Name:SKILLIN, KATHLEEN ELLEN (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ELLEN
Last Name:SKILLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15005 SHADY GROVE RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6340
Mailing Address - Country:US
Mailing Address - Phone:301-294-8525
Mailing Address - Fax:
Practice Address - Street 1:15005 SHADY GROVE RD
Practice Address - Street 2:SUITE 130
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6340
Practice Address - Country:US
Practice Address - Phone:301-294-8525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005507363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant