Healthcare Provider Details

I. General information

NPI: 1265006902
Provider Name (Legal Business Name): HANNAH REBEKAH PRONTIKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2021
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 SENECA TRL S
PETERSTOWN WV
24963-5040
US

IV. Provider business mailing address

3115 SENECA TRL S
PETERSTOWN WV
24963-5040
US

V. Phone/Fax

Practice location:
  • Phone: 304-753-9100
  • Fax: 304-753-9353
Mailing address:
  • Phone: 304-753-9100
  • Fax: 304-753-9353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number862
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: