Provider Demographics
NPI:1689802415
Name:MEHALL, KATHLEEN A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:MEHALL
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:241 SCHOOLHOUSE RD STE 201
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-3239
Practice Address - Country:US
Practice Address - Phone:814-288-2669
Practice Address - Fax:814-288-2667
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2023-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMA053868363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical