Provider Demographics
NPI:1770108474
Name:WILCOVE, KAITLIN (RPA-C)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:WILCOVE
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5036
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10602-5036
Mailing Address - Country:US
Mailing Address - Phone:845-745-3611
Mailing Address - Fax:
Practice Address - Street 1:6 HENRY ST
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-3058
Practice Address - Country:US
Practice Address - Phone:845-831-0400
Practice Address - Fax:845-765-9400
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2025-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025390363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06320869Medicaid