Provider Demographics
NPI:1730368465
Name:VALASEK, KELLY A (PA-C)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:VALASEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1549
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16003-1549
Mailing Address - Country:US
Mailing Address - Phone:724-284-4060
Mailing Address - Fax:724-284-4144
Practice Address - Street 1:102 TECHNOLOGY DR STE 230
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-1784
Practice Address - Country:US
Practice Address - Phone:877-661-3376
Practice Address - Fax:724-482-2212
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2018-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA055087363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032288870001Medicaid
PACAQHOther12295748
PA229532Medicare PIN