Provider Demographics
NPI:1609937507
Name:HASKINS, BETHANY A (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:BETHANY
Middle Name:A
Last Name:HASKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:
Other - Last Name:HOMYAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1322 EISENHOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-3307
Mailing Address - Country:US
Mailing Address - Phone:814-536-8969
Mailing Address - Fax:814-536-7180
Practice Address - Street 1:1322 EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3307
Practice Address - Country:US
Practice Address - Phone:814-536-8969
Practice Address - Fax:814-536-7180
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052224208000000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007708200001Medicaid