Provider Demographics
NPI:1376530402
Name:DAVIS, HEATHER A (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:A
Last Name:DAVIS
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 1:250 CETRONIA RD STE 302
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-9168
Mailing Address - Country:US
Mailing Address - Phone:610-437-2378
Mailing Address - Fax:610-820-9983
Practice Address - Street 1:250 CETRONIA RD STE 302
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9168
Practice Address - Country:US
Practice Address - Phone:610-437-2378
Practice Address - Fax:610-820-9983
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051472363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA074551GDKMedicare ID - Type Unspecified
PAQ00828Medicare UPIN