Provider Demographics
NPI:1447222930
Name:HIATT, SHARI JEAN (PA)
Entity Type:Individual
Prefix:MRS
First Name:SHARI
Middle Name:JEAN
Last Name:HIATT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHARI
Other - Middle Name:JEAN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:UNMH FAMILY PRACTICE 24
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-3630
Mailing Address - Country:US
Mailing Address - Phone:505-272-1734
Mailing Address - Fax:928-774-6687
Practice Address - Street 1:5904 HOLLY AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2472
Practice Address - Country:US
Practice Address - Phone:505-298-2505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2022-0103363A00000X, 363AM0700X
AZ3535363A00000X
NH0303P363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ324670Medicaid
NH30331845Medicaid
AZZ146121Medicare Oscar/Certification
NH30331845Medicaid