Basic Information
| Provider Information | |||||||||
| NPI: | 1821054677 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | METZLER | ||||||||
| FirstName: | KELLIE | ||||||||
| MiddleName: | JACLYN | ||||||||
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| Credential: | PA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KWIATKOWSKI | ||||||||
| OtherFirstName: | KELLIE | ||||||||
| OtherMiddleName: | J | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1000 BOWER HILL ROAD | ||||||||
| Address2: | ATTN ST CLAIR HOSPITAL - AFFILIATE BILLING - PAMALYN | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152431873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129422548 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1145 BOWER HILL RD STE 105 | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152431346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125796194 | ||||||||
| FaxNumber: | 4125726195 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 03/18/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | MA050811 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
No ID Information.