MEDICARE: MISS CARISSA LEIGH HEIBEL P.A.

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	363AS0400X	Surgical Physician Assistant	2128	TN
2	363A00000X	Physician Assistant	0010-04977	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P01120793	OTHER	TN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	187725	OTHER	NC	BCBS NC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P01423324	OTHER	NC	MDCR RR
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689836306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CARISSA LEIGH HEIBEL P.A.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-316-5100
Fax Number	:	704-316-5101

Provider Business Practice Location Address
First Line	:	125 QUEENS RD STE 250
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-3419
Country	:	US
Telephone Number	:	704-316-5100
Fax Number	:

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

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	05/19/2026

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Directions to “ MISS CARISSA LEIGH HEIBEL P.A.” Practice Location

Language	Start Address	Practice Location

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