Provider Demographics
NPI:1497762108
Name:REESMAN, HEATHER NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:NICOLE
Last Name:REESMAN
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 1:227 MEDICAL PARK DR
Mailing Address - Street 2:STE 101
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-9038
Mailing Address - Country:US
Mailing Address - Phone:681-342-3500
Mailing Address - Fax:
Practice Address - Street 1:227 MEDICAL PARK DR
Practice Address - Street 2:STE 101
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330-9038
Practice Address - Country:US
Practice Address - Phone:681-342-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV01100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001835129OtherBC/BS NUMBER
WV0098351000Medicaid
WVPA23561Medicare ID - Type UnspecifiedPA-C
5110270001Medicare NSC
WVQ25003Medicare UPIN