Provider Demographics
NPI:1417741778
Name:HEINEN, CHRISTOPHER (PA-C)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:HEINEN
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 1:402 RUNNING BEAR CT
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-4512
Mailing Address - Country:US
Mailing Address - Phone:817-938-0678
Mailing Address - Fax:
Practice Address - Street 1:600 N ROME ST
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76402-0001
Practice Address - Country:US
Practice Address - Phone:817-938-0678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA18830363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant