Provider Demographics
NPI:1801694914
Name:HICKEY, KAITLYN ROSE (PA)
Entity type:Individual
Prefix:MS
First Name:KAITLYN
Middle Name:ROSE
Last Name:HICKEY
Suffix:
Gender:
Credentials:PA
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Mailing Address - Street 1:616 CAPITOL PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-2614
Mailing Address - Country:US
Mailing Address - Phone:919-780-9198
Mailing Address - Fax:
Practice Address - Street 1:2 MEDICAL PARK RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6808
Practice Address - Country:US
Practice Address - Phone:803-296-7864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical