Provider Demographics
NPI:1346558251
Name:HEADLEE, CAREY ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CAREY
Middle Name:ANN
Last Name:HEADLEE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAREY
Other - Middle Name:
Other - Last Name:CORLISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3020 CHILDRENS WAY # MC5003
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-309-6300
Mailing Address - Fax:
Practice Address - Street 1:7920 FROST ST STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4289
Practice Address - Country:US
Practice Address - Phone:858-966-8603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-14
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA60069363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant