Provider Demographics
NPI:1164420519
Name:ADAMS, HEATHER P (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:P
Last Name:ADAMS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:PELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:5050 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-1216
Mailing Address - Country:US
Mailing Address - Phone:814-877-8950
Mailing Address - Fax:
Practice Address - Street 1:5050 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1216
Practice Address - Country:US
Practice Address - Phone:814-877-8950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051505363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA075757F92Medicare ID - Type Unspecified
PAQB4434Medicare UPIN