Provider Demographics
NPI:1376144998
Name:PSENICK, MIKAYLA RAE (PA-C)
Entity Type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:RAE
Last Name:PSENICK
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 1:206 NORTHGLEN CT
Mailing Address - Street 2:
Mailing Address - City:GIBSONIA
Mailing Address - State:PA
Mailing Address - Zip Code:15044-8051
Mailing Address - Country:US
Mailing Address - Phone:724-591-3583
Mailing Address - Fax:
Practice Address - Street 1:5200 CENTRE AVE STE 415
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15232-1311
Practice Address - Country:US
Practice Address - Phone:412-802-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061973363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant