Individual
MS. PAULA RENEE MIKSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
598 JOHN DEERE DRIVE, MAYNARDVILLE, TN 37807
(865) 992-6060
Mailing address
101 W 27TH ST, LUMBERTON, NC 28358-3014
(910) 739-0770
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-05096
NC
363A00000X
Physician Assistant
1271
TN
363A00000X
Physician Assistant
PA2079
SC
363AM0700X
Medical Physician Assistant
003964
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009936047
—
AL
05
—
150877
—
TN
01
—
229393905
CHAMPUS
GA
05
—
617410018A
—
GA
Enumeration date
06/06/2006
Last updated
10/30/2014
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