Provider Demographics
NPI:1952145450
Name:KISSELL, OLIVIA (PA-C)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:
Last Name:KISSELL
Suffix:
Gender:F
Credentials:PA-C
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:155 GOLF COURSE RD
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:PA
Mailing Address - Zip Code:15946-6014
Mailing Address - Country:US
Mailing Address - Phone:814-931-4447
Mailing Address - Fax:
Practice Address - Street 1:16 WATER ST STE 101
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-1237
Practice Address - Country:US
Practice Address - Phone:814-283-5535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant