Basic Information
| Provider Information | |||||||||
| NPI: | 1295347466 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEAVEY | ||||||||
| FirstName: | KATELYNN | ||||||||
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| Credential: | MS, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7 1/2 BACON STREET | ||||||||
| Address2: | |||||||||
| City: | GLENS FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12801 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 211 CHURCH ST | ||||||||
| Address2: | |||||||||
| City: | SARATOGA SPGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128661003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185873222 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2020 | ||||||||
| LastUpdateDate: | 08/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 025144-01 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.