Provider Demographics
NPI:1043317365
Name:VINCENT, HEATHER M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:M
Last Name:VINCENT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4237 RIVER HILLS DR STE 150
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-6446
Mailing Address - Country:US
Mailing Address - Phone:843-281-2778
Mailing Address - Fax:843-281-2785
Practice Address - Street 1:4237 RIVER HILLS DR STE 150
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-6446
Practice Address - Country:US
Practice Address - Phone:843-281-2778
Practice Address - Fax:843-281-2785
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV882363A00000X
SC2605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810004178Medicaid
P39631Medicare UPIN
WVPA17741Medicare PIN