Basic Information
| Provider Information | |||||||||
| NPI: | 1588630602 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEISELMAN | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 YORKSHIRE ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288037785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282741600 | ||||||||
| FaxNumber: | 8282741603 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 YORKSHIRE ST STE 201 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288037785 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282741600 | ||||||||
| FaxNumber: | 8282741603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2006 | ||||||||
| LastUpdateDate: | 01/03/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 93-00255 | NC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8941068 | 05 | NC | MEDICAID |