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General NPI Number Information
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NPI Number | 1326006214
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Entity Type | Individual
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Provider Name | SHANNON BRACKETT HEUTS PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/02/2006
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Last Update Date | 02/21/2022
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Provider Practice Location Address
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Address Line | 6411 WATERS EDGE DR
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City | ROCKY MOUNT
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State | NC
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Zip | 27803-8925
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Country | US
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Telephone | 252-442-7462
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Fax | 252-962-6671
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Provider Business Mailing Address
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Address Line | 6411 WATERS EDGE DR
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City | ROCKY MOUNT
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State | NC
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Zip | 27803-8925
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Country | US
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Telephone | 252-442-7462
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA 3510
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 0010-00629
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-00629
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License Number State | NC
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