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NPI Code Detail

MEDICARE: MRS. KELLI NICOLE HEER PA-C

MEDICARE: MRS. KELLI NICOLE HEER PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantPA 803AL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA.803OTHERALAL PHYSICIAN ASSISTANT

General Provider Information

NPI Number : 1134498132
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLI NICOLE HEER PA-C
Provider Business Mailing Address
First Line : 2505 HARRISON AVE
Second Line :
City : PANAMA CITY
State : FL
Zip : 32405-4464
Country : US
Telephone Number : 850-233-3376
Fax Number : 850-522-8354
Provider Business Practice Location Address
First Line : 106 WESTSIDE DR
Second Line :
City : DOTHAN
State : AL
Zip : 36303-1908
Country : US
Telephone Number : 877-231-3376
Fax Number : 850-522-8354
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2011
Last Update Date : 10/12/2020

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