MEDICARE: MRS. KATTIE JANE VINCENT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	OA002725	PA
2	363A00000X	Physician Assistant	MA055114	PA
3	363A00000X	Physician Assistant	016356	NY

General Provider Information

NPI Number	:	1528335072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATTIE JANE VINCENT PA-C

Provider Business Mailing Address
First Line	:	406 W OAK ST
Second Line	:
City	:	TITUSVILLE
State	:	PA
Zip	:	16354-1499
Country	:	US
Telephone Number	:	814-827-9675
Fax Number	:	814-827-4750

Provider Business Practice Location Address
First Line	:	339 W SPRING ST
Second Line	:
City	:	TITUSVILLE
State	:	PA
Zip	:	16354-1655
Country	:	US
Telephone Number	:	814-827-9675
Fax Number	:	814-827-4750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2011
Last Update Date	:	09/17/2020

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