Provider Demographics
NPI:1710976212
Name:HEYDUK, DANIEL KERBY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:KERBY
Last Name:HEYDUK
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:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER
Mailing Address - State:SD
Mailing Address - Zip Code:57579-0410
Mailing Address - Country:US
Mailing Address - Phone:605-259-3333
Mailing Address - Fax:
Practice Address - Street 1:153 S MAIN
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:SD
Practice Address - Zip Code:57555
Practice Address - Country:US
Practice Address - Phone:605-856-2295
Practice Address - Fax:605-856-2755
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0420363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS89679Medicare UPIN