Heather Lynn Widell, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

1100 Wilford Hall Loop
Lackland Afb, TX 78236-5638

Phone

(210) 808-3415

NPI assigned

May 6, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Linda Munro Psy D PA

  • Military Hospital
  • Robins Afb, GA
  • NPI 1689886137
  NPD (past)

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

{
    "created_epoch": "1399334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734480000000",
    "number": "1902216377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 WILFORD HALL LOOP",
            "city": "LACKLAND AFB",
            "state": "TX",
            "postal_code": "782365638",
            "telephone_number": "210-808-3415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 WILFORD HALL LOOP",
            "city": "LACKLAND AFB",
            "state": "TX",
            "postal_code": "782365638",
            "telephone_number": "210-808-3415"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "655 7th St Bldg 700",
            "address_purpose": "LOCATION",
            "city": "Robins AFB",
            "state": "GA",
            "postal_code": "310982227",
            "country_code": "US",
            "telephone_number": "478-327-7758",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "23D Medical Group 3278 Mitchell Blvd",
            "address_purpose": "LOCATION",
            "city": "Moody AFB",
            "state": "GA",
            "postal_code": "316991302",
            "country_code": "US",
            "telephone_number": "229-257-1459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WIDELL",
        "first_name": "HEATHER",
        "middle_name": "LYNN",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-06",
        "last_updated": "2024-12-18",
        "certification_date": "2024-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melody Vinson
• Jane Ballard Ward, MD
• Brian Michael Waters, MD
• Whasc
• Deborah Anne White, MSN, RN, WHNP-BC
• Chester Allen Wilds, IDMT
• Wilford Hall Medical Center
• Willford Hall Medical Ctr
• Willford Hall Medical Ctr
• Willford Hall Medical Ctr

• Medical Physician Assistant in Lackland Afb, TX
• Providers in Lackland Afb, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.