Active NPI
Holli Kubalak, PA-C
- Physician Assistant
- University Park, PA
National Provider Identifier
1770602724
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- MA-002017-L
- Practice address
- 308 Student Health Center
University Park, PA 16802 - Phone
- (814) 863-6747
- Fax
- (814) 863-8464
- NPI assigned
- Mar 29, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MA-002017-L | PA | Primary |
Addresses
Primary practice location
308 Student Health Center
University Park, PA 16802
Mailing address
308 Student Health Center
University Park, PA 16802
Phone (814) 863-6747
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA-002017-L | PA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University Ambulance Service | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Land Ambulance
- University Park, PA
- NPI 1255457057
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591142400000",
"number": "1770602724",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "308 STUDENT HEALTH CENTER",
"city": "UNIVERSITY PARK",
"state": "PA",
"postal_code": "16802",
"telephone_number": "814-863-6747",
"fax_number": "814-863-8464"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "308 STUDENT HEALTH CENTER",
"city": "UNIVERSITY PARK",
"state": "PA",
"postal_code": "16802",
"telephone_number": "814-863-6747",
"fax_number": "814-863-8464"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KUBALAK",
"first_name": "HOLLI",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-29",
"last_updated": "2020-06-03",
"certification_date": "2020-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "PA",
"license": "MA-002017-L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in University Park, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.