Provider Demographics
NPI: | 1922307982 |
---|---|
Name: | TWOEY, KATIE LYNN (PAC) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | KATIE |
Middle Name: | LYNN |
Last Name: | TWOEY |
Suffix: | |
Gender: | F |
Credentials: | PAC |
Other - Prefix: | MS |
Other - First Name: | KATIE |
Other - Middle Name: | LYNN |
Other - Last Name: | HECKENBERRY |
Other - Suffix: | |
Other - Last Name Type: | Other Name |
Other - Credentials: | PA-C |
Mailing Address - Street 1: | PO BOX 319 |
Mailing Address - Street 2: | 50 BIGLER ROAD |
Mailing Address - City: | BIGLER |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 16825-0319 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 814-342-5678 |
Mailing Address - Fax: | 814-342-0532 |
Practice Address - Street 1: | 1633 PHILIPSBURG BIGLER HIGHWAY |
Practice Address - Street 2: | |
Practice Address - City: | PHILIPSBURG |
Practice Address - State: | PA |
Practice Address - Zip Code: | 16866 |
Practice Address - Country: | US |
Practice Address - Phone: | 814-342-5678 |
Practice Address - Fax: | 814-342-0532 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2011-03-16 |
Last Update Date: | 2024-03-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
PA | MA054671 | 363A00000X, 207Y00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | |
Yes | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
331215MT4 | Medicare PIN |