Basic Information
Provider Information
NPI: 1538783030
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WELSH
FirstName: KAYLA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 520 GREENBRIAR RD
Address2:  
City: YORK
State: PA
PostalCode: 174041335
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 520 GREENBRIAR RD
Address2:  
City: YORK
State: PA
PostalCode: 174041335
CountryCode: US
TelephoneNumber: 7178495465
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/01/2020
LastUpdateDate: 07/13/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/13/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XMA061632PAN Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363A00000XOA005243PAY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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