MEDICARE: KACIE MADISON HEICHELBECH

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		KY
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1831083369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KACIE MADISON HEICHELBECH

Provider Business Mailing Address
First Line	:	PO BOX 936
Second Line	:
City	:	LONDON
State	:	KY
Zip	:	40743-0936
Country	:	US
Telephone Number	:	606-330-7835
Fax Number	:	859-263-1290

Provider Business Practice Location Address
First Line	:	211 FOUNTAIN CT STE 340
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-2957
Country	:	US
Telephone Number	:	859-263-1280
Fax Number	:	859-263-1290

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

Provider Enumeration Date	:	06/09/2025
Last Update Date	:	01/22/2026

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