Healthcare Provider Details

I. General information

NPI: 1154814366
Provider Name (Legal Business Name): MICHAELLA C CAREY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 COLONNADE WAY
STATE COLLEGE PA
16803-2309
US

IV. Provider business mailing address

500 UNIVERSITY DR
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 814-272-4445
  • Fax:
Mailing address:
  • Phone: 800-243-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMD059813
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA059813
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1035203660001
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
IdentifierMA059813
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerLICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: