Provider Demographics
NPI:1700037637
Name:HALENKAMP, HEATHER ALLARDYCE (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ALLARDYCE
Last Name:HALENKAMP
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARIE
Other - Last Name:ALLARDYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:12700 SOUTHFORK RD STE 260
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3288
Mailing Address - Country:US
Mailing Address - Phone:314-543-5270
Mailing Address - Fax:
Practice Address - Street 1:12700 SOUTHFORK RD STE 260
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3288
Practice Address - Country:US
Practice Address - Phone:314-543-5270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010020231363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC37626077Medicare PIN
MOMA1233044Medicare PIN