Individual
JACQUELINE L. HEISER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
265 W UNION ST STE A, ATHENS, OH 45701-2313
(740) 594-2456
(740) 594-9630
Mailing address
126 PARKS HALL, ATHENS, OH 45701-1359
(740) 593-4609
(740) 593-4166
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
1914
WV
207P00000X
Emergency Medicine Physician
34-007066
OH
207Q00000X
Family Medicine Physician
Primary
34.007066
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000181876
UNISON MEDICAID
OH
01
—
000000196979
ANTHEM BCBS
—
01
—
080160257
RR MEDICARE
—
01
—
2133702
MOLINA MEDICAID
OH
05
—
2133702
—
OH
01
—
310917085094
CARESOURCE MEDICAID
OH
05
—
5600439000
—
WV
Enumeration date
05/27/2006
Last updated
06/01/2015
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