Basic Information
| Provider Information | |||||||||
| NPI: | 1609281518 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEAPHY | ||||||||
| FirstName: | CATHERINE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1303 NE CUSHING DR | ||||||||
| Address2: | STE 100 | ||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977013887 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413882333 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2275 NE DOCTORS DR STE 6 | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977016092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5417066915 | ||||||||
| FaxNumber: | 5417066733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2014 | ||||||||
| LastUpdateDate: | 12/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 1609281518 | 01 | NPI | OTHER |