KEVIN HEIDRICK (NPI# 1891884268) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891884268 |
| Entity Type | Individual |
| Full Name | KEVIN HEIDRICK |
| Credential | P.A.-C |
| Practice Address |
1175 Mount Hood Avenue Woodburn OR 97071 |
| Mailing Address |
Po Box 190 Toppenish WA 98948-0190 |
| Practice Telephone | 5039822000 |
| Practice Fax Number | 5039820660 |
| Mailing Telephone | 5098655898 |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2012-12-20 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA00369 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | REGENCE | 067463016 | 01 |
| PACIFIC SOURCE | M066501 | 01 | |
| COMMERCIAL | 911019392 | 01 |
| Street Address |
1175 MOUNT HOOD AVENUE |
| City | WOODBURN |
| State | OR |
| Zip Code | 97071 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902995376 | Denise Chun | Family Medicine | 1175 Mount Hood Avenue, Woodburn, OR 97071 | 2006-10-12 |
| 1538387824 | Yakim Valley Farm Workers Clinic | Pharmacy | 1175 Mount Hood Avenue, Woodburn, OR 97071 | 2007-04-23 |
| 1700975174 | John Hayes | Family Medicine | 1175 Mount Hood Avenue, Woodburn, OR 97071 | 2006-10-12 |
| 1528157997 | Jeanne Savage | Family Medicine | 1175 Mount Hood Avenue, Woodburn, OR 97071 | 2006-10-12 |
| 1437248804 | Mark Mullenbach | Dentist | 1175 Mount Hood Avenue, Woodburn, OR 97071 | 2006-10-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629628839 | Carla Frances Halvorson | Technician | 955 Carol St Apt D, Woodburn, OR 97071 | 2019-09-19 |
| 1851801856 | Angela Hill | Massage Therapist | 564 Ray J Glatt Cirle, Woodburn, OR 97071 | 2017-10-04 |
| 1154713295 | Theresa Donavant-butler | Massage Therapist | 564 Glatt Circle, Woodburn, OR 97071 | 2015-02-26 |
| 1710257878 | Darlene Jost-babin | Counselor | 693 Ray J Glatt Circle, Woodburn, OR 97071 | 2012-01-06 |
| 1932401437 | Marcelino Mauro Vera Ramirez | Chiropractor | 844 Pana Street, Woodburn, OR 97071 | 2010-12-03 |
| 1801110994 | Woodburn Cosmetic & Family Dentistry P.C. | Dentist | 1018 N. Boones Ferry Rd., Woodburn, OR 97071 | 2010-03-18 |
| 1568786911 | Woodburn Dental Group, P.C. | Dentist | 1034 N. Boones Ferry Rd., Woodburn, OR 97071 | 2010-03-15 |
| 1134384985 | Roberto Diaz Camarillo | Counselor | 399 Young Street, Woodburn, OR 97071 | 2008-07-22 |
| 1447431705 | Patricia Eddy | Physical Therapist | 1475 Mt Hood Avenue, Woodburn, OR 97071 | 2007-11-15 |
| 1992926471 | Marquis Physical Therapy & Spine Rehab, PC | Physical Therapist | 2241 Country Club Rd, Woodburn, OR 97071 | 2007-05-01 |
| Find all providers in zip 97071 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215011820 | Marguerite Mautner Ballard | Physician Assistant | 2050 Progress Way, Woodburn, OR 97071-9764 | 2006-10-24 |
| 1831273457 | Miriam Habafy | Physician Assistant | 2050 Progress Way, Woodburn, OR 97071-9764 | 2006-10-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942808605 | Pilar Lorena Lopez | Physician Assistant | 7675 Sw Spruce St, Tigard, OR 97223-8723 | 2020-10-15 |
| 1730787615 | Michael Hisao Mun Ho Pang | Physician Assistant | 1245 Sw 160th Ave, Beaverton, OR 97006-5052 | 2020-10-13 |
| 1144834805 | Logan Michael Johnston | Physician Assistant | 3319 Edgeview Ln, Forest Grove, OR 97116-1094 | 2020-09-01 |
| 1285255851 | Darby Samantha Jalbert | Physician Assistant | 2480 Liberty St Ne Ste 110, Salem, OR 97301-8381 | 2020-05-05 |
| 1033751433 | Trisha K Loch | Physician Assistant | 781 W Central, Sutherlin, OR 97479 | 2019-10-17 |
| 1154805729 | Ronald William Strohmeyer | Physician Assistant | 2327 S.w. 4th Ave, Ontario, OR 97914 | 2018-09-19 |
| 1740797166 | Joseph Something | Physician Assistant | 4800 Sw 76th Ave, Portland, OR 97225-1804 | 2018-01-08 |
| 1235687013 | Satchel Harry | Physician Assistant | 417 Sw 117th Ave Fl 2, Portland, OR 97225-5924 | 2016-09-21 |
| 1093263386 | Megan Smith | Physician Assistant | 375 Park Ave Ste 5, Coos Bay, OR 97420 | 2016-09-14 |
| 1659828044 | Ryan Jones | Physician Assistant | 1775 Thompson Rd Bay Or97420, Coos Bay, OR 97420-2125 | 2016-09-02 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.