MEDICARE: MRS. HEATHER RAE MERRICK PA

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	363AM0700X	Medical Physician Assistant	PA16783	CA
2	363A00000X	Physician Assistant	PA16783	CA

General Provider Information

NPI Number	:	1528157138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER RAE MERRICK PA

Provider Business Mailing Address
First Line	:	PO BOX 62106
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93160-2106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 W PUEBLO ST
Second Line	:
City	:	SANTA BARBARA
State	:	CA
Zip	:	93105-6212
Country	:	US
Telephone Number	:	805-681-8911
Fax Number	:	805-563-9224

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	08/12/2022

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