Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mrs. Theresa Micknick, PAC

Individual provider Medical Physician Assistant · NPI 1164774261

Mrs. Theresa Micknick, PAC is a Medical Physician Assistant in Carbondale, Pennsylvania. Licensed in Pennsylvania. Registered with an NPI since 2012.

Licensed in
PA
In the registry since
2012
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

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Practice location Address checks out

165 Fallbrook St
Carbondale, PA 18433
Phone: (570) 282-3151
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence MA001651L (PA)

Record details

NPI number1164774261
Entity typeIndividual (Type 1)
GenderFemale
Credentials PAC
Sole proprietorNo
NPI enumeratedOctober 12, 2012
Last updated in NPPESOctober 12, 2012

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