# KEVIN HEIDRICK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1891884268
- **Gender:** Man
- **Credential:** P.A.-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AM0700X | Medical Physician Assistant | PA00369 | OR | Yes |

## Other

- **Enumeration date:** 10/12/2006
- **Last updated:** 12/20/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 067463016 | REGENCE | OR |
| 01 | — | 911019392 | COMMERCIAL | — |
| 01 | — | M066501 | PACIFIC SOURCE | — |