Provider Demographics
NPI:1578848446
Name:MOCK, RACHEL ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:ELIZABETH
Last Name:MOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 375
Mailing Address - Street 2:
Mailing Address - City:COALPORT
Mailing Address - State:PA
Mailing Address - Zip Code:16627-0375
Mailing Address - Country:US
Mailing Address - Phone:814-672-5141
Mailing Address - Fax:
Practice Address - Street 1:850 MAIN STREET
Practice Address - Street 2:
Practice Address - City:COALPORT
Practice Address - State:PA
Practice Address - Zip Code:16627-0375
Practice Address - Country:US
Practice Address - Phone:814-672-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053055363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant