Provider Demographics
NPI:1205082773
Name:VARNER, ALISHA LYNNE (MS, PA-C)
Entity type:Individual
Prefix:MS
First Name:ALISHA
Middle Name:LYNNE
Last Name:VARNER
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:ALISHA
Other - Middle Name:LYNNE
Other - Last Name:BOZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:125 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2665
Mailing Address - Country:US
Mailing Address - Phone:304-624-7200
Mailing Address - Fax:304-554-0404
Practice Address - Street 1:204 MARY HIGGINSON LANE
Practice Address - Street 2:
Practice Address - City:UNIONTOWN
Practice Address - State:PA
Practice Address - Zip Code:15401-2658
Practice Address - Country:US
Practice Address - Phone:724-438-8300
Practice Address - Fax:724-438-8340
Is Sole Proprietor?:No
Enumeration Date:2008-08-14
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053478363A00000X
WV01844363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVWV4620AMedicare PIN
PA321224Medicare PIN