Provider Demographics
NPI:1558103846
Name:VACHON, MIKAYLA (PA-C)
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:
Last Name:VACHON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 BLACK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:SCHELLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15559-7120
Mailing Address - Country:US
Mailing Address - Phone:814-285-2243
Mailing Address - Fax:
Practice Address - Street 1:105 NASON DR
Practice Address - Street 2:
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673-1202
Practice Address - Country:US
Practice Address - Phone:814-224-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA065709363A00000X
PAOA006907363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant