Healthcare Provider Details

I. General information

NPI: 1295755312
Provider Name (Legal Business Name): KATHLEEN BRIKMANN HEFFERON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BAYLOR DR STE 155
BLUFFTON SC
29910-8965
US

IV. Provider business mailing address

PO BOX 37643
BELFAST ME
04915-1218
US

V. Phone/Fax

Practice location:
  • Phone: 843-682-7480
  • Fax: 843-681-9169
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number011038
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4991
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: