Provider Demographics
NPI:1689645848
Name:CAIN, HEATHER S (PA-C)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:S
Last Name:CAIN
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 1:21100 ISLE OF GLASS ST
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-4081
Mailing Address - Country:US
Mailing Address - Phone:262-344-3481
Mailing Address - Fax:000-000-0000
Practice Address - Street 1:1855 GATTIS SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7428
Practice Address - Country:US
Practice Address - Phone:512-238-6268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA10872363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41963000Medicaid
P67959Medicare UPIN