Provider Demographics
NPI:1235207218
Name:STONE, HEATHER LENORE (PA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LENORE
Last Name:STONE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 HARTNELL AVE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1885
Mailing Address - Country:US
Mailing Address - Phone:530-222-2113
Mailing Address - Fax:530-222-1729
Practice Address - Street 1:191 HARTNELL AVE
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1885
Practice Address - Country:US
Practice Address - Phone:530-222-2113
Practice Address - Fax:530-222-1729
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18207363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1235207218Medicaid