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Individual

MISS CARISSA LEIGH HEIBEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
301 HAWTHORNE LN, CHARLOTTE, NC 28204
(704) 316-5100
(704) 316-5101
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 316-5100
(704) 316-5101

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-04977
NC
363AS0400X
Surgical Physician Assistant
2128
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1529055
TN
05
1689836306
NC
01
187725
BCBS NC
NC
01
P01120793
RR MEDICARE
TN
01
P01423324
MDCR RR
NC
Enumeration date
06/25/2008
Last updated
10/26/2020
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