Active NPI
Carol Jean Heitzkey, PA-C
- Physician Assistant
- Madison, WI
National Provider Identifier
1851484612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 1847-023
- Practice address
- 5618 Odana Rd
Madison, WI 53719-1208 - Phone
- (608) 274-1100
- Fax
- (608) 274-0310
- NPI assigned
- Oct 2, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 1847-023 | WI | Primary |
Addresses
Primary practice location
5618 Odana Rd
Madison, WI 53719-1208
Mailing address
7974 Uw Health Court
Middleton, WI 53562-5531
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1847 | WI | MD | Periodontist |
| 1847-023 | WI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1241136000000",
"number": "1851484612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7974 UW HEALTH COURT",
"city": "MIDDLETON",
"state": "WI",
"postal_code": "535625531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5618 ODANA RD",
"city": "MADISON",
"state": "WI",
"postal_code": "537191208",
"telephone_number": "608-274-1100",
"fax_number": "608-274-0310"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HEITZKEY",
"first_name": "CAROL",
"middle_name": "JEAN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2009-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WI",
"license": "1847-023",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Madison, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.