| Doctor Name: | KACEY A HAZELTON |
| NPI Number: | 1104122233 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C, MPAS |
| License Number: | MA054800 |
| Business Practice Address: | 414 E Drinker St Rear Suite 203 Dunmore, PA - 185122469 |
| Business Phone Number: | 5705582050 |
| Business Fax Number: | 5705582056 |
| Mailing Address: | 414 E Drinker St Rear, Suite 203 DUNMORE |
| State: | PA |
| Postal Code: | 185122469 |
| Phone Number: | 5705582050 |
| Fax Number: | 5705582056 |
| NPI Enumeration Date: | 02/08/2011 |
| NPI Last Update Date: | 10/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | MA054800 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |