Provider Demographics
NPI:1437124336
Name:FELUS-HARKER, STEPHANIE LOUISE (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LOUISE
Last Name:FELUS-HARKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:LOUISE
Other - Last Name:FELUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:517 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LYKENS
Practice Address - State:PA
Practice Address - Zip Code:17048-1520
Practice Address - Country:US
Practice Address - Phone:717-453-1073
Practice Address - Fax:717-453-8292
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002238L363AM0700X
PAOA003298363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031534630002Medicaid
PA149833FE2Medicare ID - Type Unspecified
PAP77588Medicare UPIN
PA110735Medicare PIN