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NPI Code Detail

MEDICARE: SHANNON BRACKETT HEUTS PA-C

MEDICARE:   SHANNON BRACKETT HEUTS  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 3510FL
2363AS0400XSurgical Physician Assistant0010-00629NC
3363A00000XPhysician Assistant0010-00629NC

General Provider Information

NPI Number : 1326006214
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON BRACKETT HEUTS PA-C
Provider Business Mailing Address
First Line : 6411 WATERS EDGE DR
Second Line :
City : ROCKY MOUNT
State : NC
Zip : 27803-8925
Country : US
Telephone Number : 252-442-7462
Fax Number :
Provider Business Practice Location Address
First Line : 6411 WATERS EDGE DR
Second Line :
City : ROCKY MOUNT
State : NC
Zip : 27803-8925
Country : US
Telephone Number : 252-442-7462
Fax Number : 252-962-6671
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2006
Last Update Date : 02/21/2022

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Directions to “ SHANNON BRACKETT HEUTS PA-C” Practice Location

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