Provider Demographics
NPI:1174787071
Name:YAKICH, ALEXIS A (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:A
Last Name:YAKICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:104 EAST CENTRAL AVENUE
Mailing Address - Street 2:PO BOX 430
Mailing Address - City:AVIS
Mailing Address - State:PA
Mailing Address - Zip Code:17721
Mailing Address - Country:US
Mailing Address - Phone:570-753-8620
Mailing Address - Fax:570-753-5489
Practice Address - Street 1:104 EAST CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:AVIS
Practice Address - State:PA
Practice Address - Zip Code:17721
Practice Address - Country:US
Practice Address - Phone:570-753-8620
Practice Address - Fax:570-753-5489
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant