Provider Demographics
NPI:1063855237
Name:KHALIFE, DEBORAH L (PA-C)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:KHALIFE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 JASON DR
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2726
Mailing Address - Country:US
Mailing Address - Phone:570-825-5673
Mailing Address - Fax:
Practice Address - Street 1:824 MCALPINE ST
Practice Address - Street 2:
Practice Address - City:AVOCA
Practice Address - State:PA
Practice Address - Zip Code:18641
Practice Address - Country:US
Practice Address - Phone:570-457-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA-001376-L363A00000X
PAOA000106L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant