Provider Demographics
NPI:1437964301
Name:SARCONA, KAITLYN
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:SARCONA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 ROSS RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE HOCKING
Mailing Address - State:OH
Mailing Address - Zip Code:45742-5033
Mailing Address - Country:US
Mailing Address - Phone:954-295-4695
Mailing Address - Fax:
Practice Address - Street 1:1701 7TH ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5007
Practice Address - Country:US
Practice Address - Phone:304-485-9027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV122029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily