Provider Demographics
NPI:1235228446
Name:PAIT, HEATHER L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:PAIT
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 1:2002 N CEDAR ST STE B
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3926
Mailing Address - Country:US
Mailing Address - Phone:910-272-3048
Mailing Address - Fax:910-738-3764
Practice Address - Street 1:9858 NORTH WR LATHAM STREET
Practice Address - Street 2:
Practice Address - City:CLARKTON
Practice Address - State:NC
Practice Address - Zip Code:28433-2011
Practice Address - Country:US
Practice Address - Phone:910-647-1503
Practice Address - Fax:910-647-1505
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103785363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ27137Medicare UPIN