Provider Demographics
NPI:1538285077
Name:RAMSEY, MAKISHA TAMSEN (PA-C)
Entity Type:Individual
Prefix:
First Name:MAKISHA
Middle Name:TAMSEN
Last Name:RAMSEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 BLACKBIRD WAY APT 31
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:WV
Mailing Address - Zip Code:24901-1291
Mailing Address - Country:US
Mailing Address - Phone:304-673-7523
Mailing Address - Fax:304-438-6819
Practice Address - Street 1:645 KANAWHA AVE
Practice Address - Street 2:
Practice Address - City:RAINELLE
Practice Address - State:WV
Practice Address - Zip Code:25962-1013
Practice Address - Country:US
Practice Address - Phone:304-438-6188
Practice Address - Fax:304-438-6819
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV01227363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1538285077Medicaid
WVRA2032051Medicare PIN
WVWV1395B278Medicare PIN