Provider Demographics
NPI:1659796274
Name:HEIDEMAN, CHRISTOPHER K (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:K
Last Name:HEIDEMAN
Suffix:
Gender:M
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 1:4972 S MARYLAND PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-1531
Mailing Address - Country:US
Mailing Address - Phone:702-740-4789
Mailing Address - Fax:702-704-8394
Practice Address - Street 1:4972 S MARYLAND PKWY STE 2
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-1531
Practice Address - Country:US
Practice Address - Phone:702-740-4789
Practice Address - Fax:702-704-8394
Is Sole Proprietor?:No
Enumeration Date:2014-02-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1505363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV02087OtherNEVADA BORAD OF PHARMACY, #02087
NVCS21714OtherNEVADA BOARD OF LICENSE # CS21714
PA1505OtherNEVADA BORAD OF MEDICINE
PA1505OtherNEVADA BORAD OF MEDICINE