MEDICARE: MISTY J HARAWAY PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA 1113	OK

General Provider Information

NPI Number	:	1457331076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISTY J HARAWAY PA

Provider Business Mailing Address
First Line	:	116 SW 2ND ST
Second Line	:
City	:	CHECOTAH
State	:	OK
Zip	:	74426-3602
Country	:	US
Telephone Number	:	918-473-2278
Fax Number	:

Provider Business Practice Location Address
First Line	:	116 SW 2ND ST
Second Line	:
City	:	CHECOTAH
State	:	OK
Zip	:	74426-3602
Country	:	US
Telephone Number	:	918-473-2278
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	11/30/2010

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