Individual provider Active NPI

Aliyah Fetterolf, PA-C

  • Physician Assistant
  • State College, PA
National Provider Identifier
1982588653
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA066882 Issued in PA
Practice address
200 Scenery Dr
State College, PA 16801-7974
Phone
(814) 231-4560
Fax
(814) 231-6246
NPI assigned
Aug 4, 2025
Last updated
Oct 1, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA066882 PA Primary
Physician Assistant 363A00000X OA007365 PA

Addresses

Primary practice location

200 Scenery Dr
State College, PA 16801-7974

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (814) 231-4560

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251101000325 PA Practitioner - Physician Assistant 8628567252 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

200 Scenery Dr
State College, PA 16801-7974
Phone (814) 231-4560

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
MA066882PAMDPhysician Assistant
OA007365PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic CurrentSince Oct 20, 2025 Accepting new patients
Geisinger Clinic Physician Assistant Current Accepting new patients
Geisinger Clinic CurrentSince Oct 20, 2025 Accepting new patients
Geisinger Clinic Past Accepting new patients

Locations

100 N Academy Ave
Danville, PA 17822

400 Highland Ave
Lewistown, PA 17044
Phone (717) 242-7473

1800 Mulberry St
Scranton, PA 18510
Phone (570) 703-7351

200 Scenery Dr
State College, PA 16801
Phone (814) 231-4560

1000 E Mountain Dr
Wilkes Barre, PA 18711
Phone (570) 826-7300

950 E Mountain Dr
Wilkes Barre, PA 18711
Phone (570) 808-3200

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1754265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759276800000",
    "number": "1982588653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "814-231-4560",
            "fax_number": "814-231-6246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SCENERY DR",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168017974",
            "telephone_number": "814-231-4560",
            "fax_number": "814-231-6246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETTEROLF",
        "first_name": "ALIYAH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-04",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA066882",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "OA007365",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in State College, PA

Sources for this page

Verify at the official NPI Registry.