Provider Demographics
NPI:1952199051
Name:PACHECO, KATELYN DIANE (PA)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:DIANE
Last Name:PACHECO
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 LENAPE TRL
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-2143
Mailing Address - Country:US
Mailing Address - Phone:908-619-5459
Mailing Address - Fax:
Practice Address - Street 1:63 LENAPE TRL
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-2143
Practice Address - Country:US
Practice Address - Phone:908-619-5459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant