Provider Demographics
NPI:1619901568
Name:SHIFLETT, HEATHER ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:SHIFLETT
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 1:8015 FARMBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7123
Mailing Address - Country:US
Mailing Address - Phone:704-667-2650
Mailing Address - Fax:704-544-0172
Practice Address - Street 1:1040 EDGEWATER CORPORATE PKWY STE 104
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29707-4526
Practice Address - Country:US
Practice Address - Phone:803-547-8660
Practice Address - Fax:704-544-0172
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1328363AS0400X
NC102370363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1619901568Medicaid
NC8102101Medicaid
SC1865PAMedicaid
NC2750633PMedicare PIN
NC2750633BMedicare PIN
NC2750633NMedicare PIN
NC2750633RMedicare PIN
NC1619901568Medicaid
NC2750633MMedicare PIN
NC2750633FMedicare PIN
NC8102101Medicaid
SCSC32847772Medicare PIN
NC2750633SMedicare PIN
NC2750633WMedicare PIN
SC1865PAMedicaid
NC2750633CMedicare PIN
NC2750633UMedicare PIN
NC2750633HMedicare PIN
NC2750633KMedicare PIN