Provider Demographics
NPI:1568819456
Name:ANGLESON, KARISSA WESS (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KARISSA
Middle Name:WESS
Last Name:ANGLESON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KARISSA
Other - Middle Name:ROSE
Other - Last Name:WESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:USACS OFFICE, ATTN EMILY REED
Mailing Address - Street 2:835 HOSPITAL RD
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701
Mailing Address - Country:US
Mailing Address - Phone:724-357-7121
Mailing Address - Fax:
Practice Address - Street 1:INDIANA REGIONAL MEDICAL CENTER EMERGENCY DEPARTMENT
Practice Address - Street 2:835 HOSPITAL RD
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701
Practice Address - Country:US
Practice Address - Phone:724-357-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-20
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY019706-1363AM0700X
PAMA060389363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant