Provider Demographics
NPI:1134170475
Name:DOVERSPIKE, LISA KRISTINE (PA C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KRISTINE
Last Name:DOVERSPIKE
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 ONEIDA VALLEY RD STE 310
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16001-2252
Mailing Address - Country:US
Mailing Address - Phone:724-968-5330
Mailing Address - Fax:724-431-2951
Practice Address - Street 1:129 ONEIDA VALLEY RD STE 310
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2252
Practice Address - Country:US
Practice Address - Phone:617-851-6197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103181495-0001Medicaid