Provider Demographics
NPI:1063629384
Name:KEHOE, ALLISON (MPAS, PAC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:KEHOE
Suffix:
Gender:F
Credentials:MPAS, PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 12TH AVE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-3100
Mailing Address - Country:US
Mailing Address - Phone:814-944-5062
Mailing Address - Fax:814-944-5557
Practice Address - Street 1:1701 12TH AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-3100
Practice Address - Country:US
Practice Address - Phone:814-944-5062
Practice Address - Fax:814-944-5557
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMAO51313363AM0700X
PAMA051313363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical