Provider Demographics
NPI:1811633571
Name:YOCKE, MADISON ELIZABETH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:ELIZABETH
Last Name:YOCKE
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 1:94 WESTGATE DR APT B306
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-4991
Mailing Address - Country:US
Mailing Address - Phone:304-780-6412
Mailing Address - Fax:
Practice Address - Street 1:1315 MOUNT DECHANTAL ROAD
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-4991
Practice Address - Country:US
Practice Address - Phone:304-243-7117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WV2659363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program