Individual
KAYLEA ANN DERUELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4401 PENN AVE, PITTSBURGH, PA 15224-1334
(412) 692-5530
Mailing address
600 GRANT ST, PITTSBURGH, PA 15219-2702
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA063096
PA
363AM0700X
Medical Physician Assistant
MA063096
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1037308370001
—
PA
05
—
1037308370002
—
PA
05
—
1037308370003
—
PA
Enumeration date
12/27/2021
Last updated
01/21/2025
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