Provider Demographics
NPI:1801142864
Name:WIELAND, KAITLYN ELAINE (PA-C)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ELAINE
Last Name:WIELAND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-656-6122
Mailing Address - Fax:717-656-0142
Practice Address - Street 1:368 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-1761
Practice Address - Country:US
Practice Address - Phone:717-656-6122
Practice Address - Fax:717-656-0142
Is Sole Proprietor?:No
Enumeration Date:2012-07-27
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055609363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical