Provider Demographics
NPI:1700164092
Name:HEATON, RHODA E (PA)
Entity Type:Individual
Prefix:
First Name:RHODA
Middle Name:E
Last Name:HEATON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RHODA
Other - Middle Name:E
Other - Last Name:LINCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3340 E GOLDSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1026
Mailing Address - Country:US
Mailing Address - Phone:208-367-5170
Mailing Address - Fax:208-367-5180
Practice Address - Street 1:999 N CURTIS RD
Practice Address - Street 2:SUITE 415
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1334
Practice Address - Country:US
Practice Address - Phone:208-367-7676
Practice Address - Fax:208-367-5595
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant