Provider Demographics
NPI:1942719711
Name:WITCHEY, NICHOLE B (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:B
Last Name:WITCHEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:NICHOLE
Other - Middle Name:B
Other - Last Name:PARSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1034 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-2945
Mailing Address - Country:US
Mailing Address - Phone:814-373-5255
Mailing Address - Fax:814-373-5259
Practice Address - Street 1:640 ALDEN ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-2348
Practice Address - Country:US
Practice Address - Phone:814-373-5255
Practice Address - Fax:814-373-5259
Is Sole Proprietor?:No
Enumeration Date:2017-09-25
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059312363AM0700X
PAOA004263363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical