Provider Demographics
NPI:1770039927
Name:CALLAHAN, HEATHER RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:28 BLACKWELL PARK LN
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2685
Mailing Address - Country:US
Mailing Address - Phone:540-341-1900
Mailing Address - Fax:540-341-0940
Practice Address - Street 1:28 BLACKWELL PARK LN
Practice Address - Street 2:SUITE 302
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2685
Practice Address - Country:US
Practice Address - Phone:540-341-1900
Practice Address - Fax:540-641-0940
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110005467363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical