Provider Demographics
NPI:1528335072
Name:VINCENT, KATTIE JANE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KATTIE
Middle Name:JANE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KATTIE
Other - Middle Name:JANE
Other - Last Name:BEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:406 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16354-1499
Mailing Address - Country:US
Mailing Address - Phone:814-827-9675
Mailing Address - Fax:814-827-4750
Practice Address - Street 1:339 W SPRING ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16354-1655
Practice Address - Country:US
Practice Address - Phone:814-827-9675
Practice Address - Fax:814-827-4750
Is Sole Proprietor?:No
Enumeration Date:2011-11-29
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002725363A00000X
PAMA055114363A00000X
NY016356363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant