Provider Demographics
NPI:1205512860
Name:HEATON, ALEXIS ANN (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:ANN
Last Name:HEATON
Suffix:
Gender:
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 1:1301 GRUNDMAN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-3320
Mailing Address - Country:US
Mailing Address - Phone:402-873-4242
Mailing Address - Fax:402-873-4227
Practice Address - Street 1:1301 GRUNDMAN BLVD STE A
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-3320
Practice Address - Country:US
Practice Address - Phone:402-873-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3233363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant