Healthcare Provider Details

I. General information

NPI: 1417589318
Provider Name (Legal Business Name): CAROLINE JANE HEYS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 QUEENS RD STE 430
CHARLOTTE NC
28204-3579
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 980-302-6700
  • Fax: 980-302-6705
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-09713
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: