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
StateLicense IDTaxonomies
PAMA054671363A00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
331215MT4Medicare PIN