Provider Demographics
NPI:1154461416
Name:MIST, HEIDI C (MD, MPH&TM)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:C
Last Name:MIST
Suffix:
Gender:F
Credentials:MD, MPH&TM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2726
Mailing Address - Country:US
Mailing Address - Phone:530-527-7333
Mailing Address - Fax:530-527-7300
Practice Address - Street 1:1022 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2726
Practice Address - Country:US
Practice Address - Phone:530-527-7333
Practice Address - Fax:530-527-7300
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80054208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA53909GMedicaid
CAGR0089251Medicaid
CA53909GMedicaid
CAGR0089251Medicaid