Healthcare Provider Details

I. General information

NPI: 1922345867
Provider Name (Legal Business Name): HEATHER CHRISTENSEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER CLARK PA

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

689 AIRPORT CENTER SUITE B
FRIDAY HARBOR WA
98250-9825
US

IV. Provider business mailing address

9425 N NEVADA ST SUITE 300
SPOKANE WA
99218-5014
US

V. Phone/Fax

Practice location:
  • Phone: 360-378-1338
  • Fax: 509-789-9013
Mailing address:
  • Phone: 509-465-8885
  • Fax: 509-789-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-1003
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number60445208
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number60445208
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: