Provider Demographics
NPI:1225052566
Name:HEISINGER, CARRIE JO (PAC)
Entity type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:JO
Last Name:HEISINGER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 N BEAVER ST
Mailing Address - Street 2:PAYER CREDENTIALING
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3118
Mailing Address - Country:US
Mailing Address - Phone:928-773-2559
Mailing Address - Fax:928-213-6292
Practice Address - Street 1:210 SUNSET DR STE A
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-5406
Practice Address - Country:US
Practice Address - Phone:928-228-0030
Practice Address - Fax:928-291-0175
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2023-08-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ3329363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ018949Medicaid
AZ018949Medicaid
AZZ170188Medicare PIN