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: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9930 KINCEY AVE STE 165
HUNTERSVILLE NC
28078-6541
US

IV. Provider business mailing address

9930 KINCEY AVE STE 165
HUNTERSVILLE NC
28078-6541
US

V. Phone/Fax

Practice location:
  • Phone: 704-947-5005
  • Fax:
Mailing address:
  • Phone: 47-947-5005
  • 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: