Provider Demographics
NPI:1831448737
Name:FAIRMAN, KALEIGH A (PA-C)
Entity type:Individual
Prefix:
First Name:KALEIGH
Middle Name:A
Last Name:FAIRMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KALEIGH
Other - Middle Name:A
Other - Last Name:SCHUCKERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:81 HILLCREST DR STE 1300
Mailing Address - Street 2:
Mailing Address - City:PUNXSUTAWNEY
Mailing Address - State:PA
Mailing Address - Zip Code:15767-2605
Mailing Address - Country:US
Mailing Address - Phone:814-938-5910
Mailing Address - Fax:814-938-4525
Practice Address - Street 1:81 HILLCREST DR STE 1300
Practice Address - Street 2:
Practice Address - City:PUNXSUTAWNEY
Practice Address - State:PA
Practice Address - Zip Code:15767-2605
Practice Address - Country:US
Practice Address - Phone:814-938-5910
Practice Address - Fax:814-938-4525
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055652363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant