Individual
THEA HEATON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
318 2ND ST S, NAMPA, ID 83651-3765
(208) 467-3006
(208) 467-1155
Mailing address
318 2ND ST S, NAMPA, ID 83651-3765
(208) 467-3006
(208) 467-1155
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA00597
OR
363A00000X
Physician Assistant
Primary
PA474
ID
Other
Enumeration date
08/02/2005
Last updated
02/09/2016
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