Provider Demographics
NPI:1598016701
Name:GARSTECKI, ALLISON A (PA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:A
Last Name:GARSTECKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 HOSPITAL ST
Mailing Address - Street 2:SUITE 112B
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5312
Mailing Address - Country:US
Mailing Address - Phone:228-938-0700
Mailing Address - Fax:228-938-0705
Practice Address - Street 1:4105 HOSPITAL ST
Practice Address - Street 2:SUITE 112B
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5312
Practice Address - Country:US
Practice Address - Phone:228-938-0700
Practice Address - Fax:228-938-0705
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.855363A00000X
MSPA00173363AM0700X
ALPA855363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-31430OtherBLUE CROSS OF ALABAMA
AL511-31430OtherBLUE CROSS OF ALABAMA
AL102I975209Medicare PIN