Provider Demographics
NPI:1508996828
Name:HEVERLY, ELIZABETH ANNE (PA-C, MPAS)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:HEVERLY
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Gender:F
Credentials:PA-C, MPAS
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Mailing Address - Street 1:501 HOWARD AVE
Mailing Address - Street 2:STE E1
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4817
Mailing Address - Country:US
Mailing Address - Phone:814-946-9150
Mailing Address - Fax:814-946-1397
Practice Address - Street 1:501 HOWARD AVE STE F3
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4818
Practice Address - Country:US
Practice Address - Phone:814-946-9150
Practice Address - Fax:814-946-1397
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMA052176363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA052176OtherSTATE LICENSE NUMBER