Provider Demographics
NPI:1699703090
Name:COSTION, CASIE JONEL (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CASIE
Middle Name:JONEL
Last Name:COSTION
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:CASIE
Other - Middle Name:JONEL
Other - Last Name:DELIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKWAY
Mailing Address - State:PA
Mailing Address - Zip Code:15824-1620
Mailing Address - Country:US
Mailing Address - Phone:814-268-3645
Mailing Address - Fax:814-265-1795
Practice Address - Street 1:1100 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKWAY
Practice Address - State:PA
Practice Address - Zip Code:15824-1620
Practice Address - Country:US
Practice Address - Phone:814-268-3645
Practice Address - Fax:814-265-1795
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051013363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP70484Medicare UPIN