Provider Demographics
NPI:1033219241
Name:MIKLOS, HEATHER A (PA-C)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:A
Last Name:MIKLOS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:PALERMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:500 MEDICAL ARTS BLDG
Mailing Address - Street 2:SUITE 540
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7137
Mailing Address - Country:US
Mailing Address - Phone:724-543-4942
Mailing Address - Fax:724-543-8865
Practice Address - Street 1:500 MEDICAL ARTS BLDG
Practice Address - Street 2:SUITE 540
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7137
Practice Address - Country:US
Practice Address - Phone:724-543-4942
Practice Address - Fax:724-543-8865
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052696363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA005296Medicare Oscar/Certification