Healthcare Provider Details

I. General information

NPI: 1841035698
Provider Name (Legal Business Name): MIKAYLA DOVE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 SUNFLOWER DR
DU BOIS PA
15801-2364
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-6379
  • Fax: 814-375-9320
Mailing address:
  • Phone: 814-375-2200
  • Fax: 814-375-9320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOT023862
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOS025731
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: