Individual
MISS HEATHER CARLSON JUSTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPAP, PA-C
Contact information
Practice address
130 W RAVINE RD, KINGSPORT, KINGSPORT, TN 37660-3837
(423) 224-3150
(423) 224-3169
Mailing address
105 W STONE DR, KINGSPORT, KINGSPORT, TN 37660-3365
(423) 408-7220
(423) 408-7405
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
0110005244
VA
363A00000X
Physician Assistant
Primary
2863
TN
363A00000X
Physician Assistant
5601006938
MI
363A00000X
Physician Assistant
PA05331
TX
Other
Enumeration date
09/13/2007
Last updated
01/07/2016
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