Provider Demographics
NPI:1295347466
Name:HATALSKY, KATELYNN (MS, PA-C)
Entity type:Individual
Prefix:
First Name:KATELYNN
Middle Name:
Last Name:HATALSKY
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:KATELYNN
Other - Middle Name:
Other - Last Name:LEAVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-926-6992
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:35 GILBERT STREET
Practice Address - Street 2:CAMBRIDGE MEDICAL CENTER
Practice Address - City:CAMBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12816-2618
Practice Address - Country:US
Practice Address - Phone:518-677-3163
Practice Address - Fax:518-677-3180
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025144-01207P00000X
NY025144363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine