Healthcare Provider Details

I. General information

NPI: 1609937507
Provider Name (Legal Business Name): BETHANY A HASKINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANY HOMYAK

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 EISENHOWER BLVD
JOHNSTOWN PA
15904-3307
US

IV. Provider business mailing address

1322 EISENHOWER BLVD
JOHNSTOWN PA
15904-3307
US

V. Phone/Fax

Practice location:
  • Phone: 814-536-8969
  • Fax: 814-536-7180
Mailing address:
  • Phone: 814-536-8969
  • Fax: 814-536-7180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA052224
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA052224
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: