Provider Demographics
NPI:1457331076
Name:HARAWAY, MISTY J (PA)
Entity Type:Individual
Prefix:
First Name:MISTY
Middle Name:J
Last Name:HARAWAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426-3602
Mailing Address - Country:US
Mailing Address - Phone:918-473-2278
Mailing Address - Fax:
Practice Address - Street 1:116 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:CHECOTAH
Practice Address - State:OK
Practice Address - Zip Code:74426-3602
Practice Address - Country:US
Practice Address - Phone:918-473-2278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPA 1113363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P34928Medicare UPIN