Provider Demographics
NPI:1033273255
Name:HEATON, SHARON K (FNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:K
Last Name:HEATON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:K
Other - Last Name:COWIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2120
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-2120
Mailing Address - Country:US
Mailing Address - Phone:541-274-3278
Mailing Address - Fax:541-274-3275
Practice Address - Street 1:3001 DAGGETT AVE STE 101
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1126
Practice Address - Country:US
Practice Address - Phone:541-274-3278
Practice Address - Fax:541-274-3275
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200350051NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00063700OtherRAILROAD MEDICARE
OR298908Medicaid
P00063700OtherRAILROAD MEDICARE
ORQ06554Medicare UPIN