Provider Demographics
NPI:1447769112
Name:COLE, HEIDI JO (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:JO
Last Name:COLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:HEIDI
Other - Middle Name:JO
Other - Last Name:POTTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6304 HEINEMAN COURT
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-0188
Mailing Address - Country:US
Mailing Address - Phone:214-288-8981
Mailing Address - Fax:833-471-4886
Practice Address - Street 1:6304 HEINEMAN CT
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-0188
Practice Address - Country:US
Practice Address - Phone:214-288-8981
Practice Address - Fax:833-471-4886
Is Sole Proprietor?:No
Enumeration Date:2017-09-26
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA-11423363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX378041308Medicaid