Provider Demographics
NPI:1184949471
Name:KREBER, HEATHER ROSE (MSPAS, PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ROSE
Last Name:KREBER
Suffix:
Gender:F
Credentials:MSPAS, PA-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ROSE
Other - Last Name:SCRIBNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPAS, PA-C
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:801 5TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51101-1326
Practice Address - Country:US
Practice Address - Phone:712-279-2010
Practice Address - Fax:712-279-2034
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002079363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1091016OtherNCCPA
IA002079OtherPA LICENSE
IA5101342OtherSTATE CSC
IA5101342OtherSTATE CSC
IAP00838229Medicare PIN