Provider Demographics
NPI:1124475280
Name:HEVERLY, STEVEN JESS
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:JESS
Last Name:HEVERLY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 CHIQUITA LN
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3207
Mailing Address - Country:US
Mailing Address - Phone:951-790-8051
Mailing Address - Fax:
Practice Address - Street 1:5801 CHIQUITA LN
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3207
Practice Address - Country:US
Practice Address - Phone:951-790-8051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical