Theresa Micknick, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

MA001651L Issued in PA

Practice address

165 Fallbrook St
Carbondale, PA 18433

Phone

(570) 282-3151

NPI assigned

Oct 12, 2012

Last updated

Oct 12, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mr. Theresa White Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/6392/brand/1/csg/1/fhir/r4
• Direct secure messaging: theresa.micknick.1@6392.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tamrat Bekele MD

  • Internal Medicine Physician
  • Carbondale, PA
  • NPI 1184746042
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1350000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350000000000",
    "number": "1164774261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 BELL MOUNTAIN RD",
            "city": "JERMYN",
            "state": "PA",
            "postal_code": "184333611",
            "telephone_number": "570-254-4663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 FALLBROOK ST",
            "city": "CARBONDALE",
            "state": "PA",
            "postal_code": "18433",
            "telephone_number": "570-282-3151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKNICK",
        "first_name": "THERESA",
        "name_prefix": "Mrs.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-12",
        "last_updated": "2012-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA001651L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THERESA",
            "last_name": "WHITE",
            "prefix": "MR.",
            "credential": "PAC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Merakey Pennsylvania
• Merakey Pennsylvania
• Joseph W Merli
• Stephanie A Meyers, SLP
• Cindy Anne Michel, DPT
• Grace C Miller, LCSW
• Tamar Minor
• Lakshmi D Mizin, MD
• MMJM LLC (Figliomeni Pharmacy Care)
• Jacqueline Moase, LSW

• Medical Physician Assistant in Carbondale, PA
• Providers in Carbondale, PA by specialty
• Medical Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.