Provider Demographics
NPI:1659618197
Name:HANEY, JON W (PA-C)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:W
Last Name:HANEY
Suffix:
Gender:M
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 1:10 DNR RD
Mailing Address - Street 2:
Mailing Address - City:MC GRATH
Mailing Address - State:AK
Mailing Address - Zip Code:99627-0159
Mailing Address - Country:US
Mailing Address - Phone:907-524-3299
Mailing Address - Fax:907-524-3805
Practice Address - Street 1:10 DNR RD
Practice Address - Street 2:
Practice Address - City:MC GRATH
Practice Address - State:AK
Practice Address - Zip Code:99627-0159
Practice Address - Country:US
Practice Address - Phone:907-524-3299
Practice Address - Fax:907-524-3805
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKPHS000OtherIHS
OK2206OtherSTATE LICENSE