Kevin Heidrick, P.A.-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA00369 Issued in OR

Practice address

1175 Mount Hood Avenue
Woodburn, OR 97071

Phone

(503) 982-2000

Fax

(503) 982-0660

NPI assigned

Oct 12, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355961600000",
    "number": "1891884268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190",
            "city": "TOPPENISH",
            "state": "WA",
            "postal_code": "989480190",
            "telephone_number": "509-865-5898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 MOUNT HOOD AVENUE",
            "city": "WOODBURN",
            "state": "OR",
            "postal_code": "97071",
            "telephone_number": "503-982-2000",
            "fax_number": "503-982-0660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEIDRICK",
        "first_name": "KEVIN",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2012-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA00369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE",
            "identifier": "067463016",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL",
            "identifier": "911019392",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PACIFIC SOURCE",
            "identifier": "M066501",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin Minlee Haong, LMT
• Rebekah Harding
• Harmony Haven Living, LLC
• Angelina Harris, RN
• Darlene Marlene Hawley, REGISTERED NURSE
• Monica Zollner Henderson, DNP
• Janet M Hendricks, LPCI
• Kathy Herbst, LMT
• Maria D Hernandez Quetzecua
• Wendy Hernandez Reyes

• Medical Physician Assistant in Woodburn, OR
• Providers in Woodburn, OR by specialty
• Medical Physician Assistant in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.