Provider Demographics
NPI:1033281316
Name:SKAGGS, BETHANY E (PA-C)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:E
Last Name:SKAGGS
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 1:2599 WEXFORD BAYNE RD
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8769
Mailing Address - Country:US
Mailing Address - Phone:724-933-3644
Mailing Address - Fax:
Practice Address - Street 1:2599 WEXFORD BAYNE RD
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-8769
Practice Address - Country:US
Practice Address - Phone:724-933-3644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061532363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8101155Medicaid
NC2768838AMedicare PIN
NC1033281316Medicare PIN
Q79494Medicare UPIN
NC2768838Medicare PIN