Provider Demographics
NPI:1356307813
Name:JEFFREYS, HEIDI MICHELE (PA-C)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:MICHELE
Last Name:JEFFREYS
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 1:10905 QUAKER AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-8315
Mailing Address - Country:US
Mailing Address - Phone:806-722-9855
Mailing Address - Fax:806-722-7421
Practice Address - Street 1:10905 QUAKER AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-8315
Practice Address - Country:US
Practice Address - Phone:806-722-9855
Practice Address - Fax:806-722-7421
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04632363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
8G0974Medicare ID - Type Unspecified
Q54977Medicare UPIN