Provider Demographics
NPI:1699921338
Name:KAPAROS, HEATHER BROWN (PA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:BROWN
Last Name:KAPAROS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1934 ALCOA HWY
Mailing Address - Street 2:BLDG. D, SUITE 362
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1524
Mailing Address - Country:US
Mailing Address - Phone:865-305-4670
Mailing Address - Fax:865-305-4671
Practice Address - Street 1:1934 ALCOA HWY
Practice Address - Street 2:BLDG. D, SUITE 362
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1524
Practice Address - Country:US
Practice Address - Phone:865-305-4670
Practice Address - Fax:865-305-4671
Is Sole Proprietor?:No
Enumeration Date:2008-08-13
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC03061363A00000X, 363AS0400X
TN1869363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4273256OtherBLUECROSS BLUESHIELD
TN1520891Medicaid
TN4273258OtherBLUECROSS BLUESHIELD -AT SURGERY
TN103I979959Medicare PIN
TN4273258OtherBLUECROSS BLUESHIELD -AT SURGERY
TN103I975795Medicare PIN