Provider Demographics
NPI:1083672992
Name:HEASTON, GARY (PA-C)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:HEASTON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JENSEN OCCUPATIONAL MEDICAL CENTER
Mailing Address - Street 2:7238 6TH ST. BLDG 249
Mailing Address - City:HILL AIR FORCE BASE
Mailing Address - State:UT
Mailing Address - Zip Code:84056-5213
Mailing Address - Country:US
Mailing Address - Phone:801-777-1157
Mailing Address - Fax:
Practice Address - Street 1:7238 6TH ST
Practice Address - Street 2:JENSEN OCCUPATIONAL MEDICINE CENTER, BLDG. 249
Practice Address - City:HILL AIR FORCE BASE
Practice Address - State:UT
Practice Address - Zip Code:84056-5213
Practice Address - Country:US
Practice Address - Phone:801-777-1157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT324779-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant