Healthcare Provider Details

I. General information

NPI: 1316712573
Provider Name (Legal Business Name): MAKAYLA GLOVER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2023
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4247 W RIDGE RD STE 105
ERIE PA
16506-1746
US

IV. Provider business mailing address

2 ALLEGHENY CTR STE 530
PITTSBURGH PA
15212-5404
US

V. Phone/Fax

Practice location:
  • Phone: 814-833-3002
  • Fax:
Mailing address:
  • Phone: 412-330-5851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA065261
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: