MEDICARE: DR. KARI CASE HEISTAND M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD00045509	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043301930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARI CASE HEISTAND M.D.

Provider Business Mailing Address
First Line	:	96 TWINSVIEW CT
Second Line	:
City	:	PORT LUDLOW
State	:	WA
Zip	:	98365-9219
Country	:	US
Telephone Number	:	360-621-9475
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 POLK ST STE 4A
Second Line	:
City	:	PORT TOWNSEND
State	:	WA
Zip	:	98368-6739
Country	:	US
Telephone Number	:	360-385-9918
Fax Number	:	360-385-1496

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	04/29/2021

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