Provider Demographics
NPI:1508397852
Name:BICKERTON, CATHY (PA-C)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:BICKERTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:
Other - Last Name:SHALLENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:602 LOUCKS AVE
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-1524
Mailing Address - Country:US
Mailing Address - Phone:724-806-0167
Mailing Address - Fax:
Practice Address - Street 1:9400 MCKNIGHT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-6007
Practice Address - Country:US
Practice Address - Phone:724-591-5236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001055L363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant