Provider Demographics
NPI:1962590810
Name:HEADRICK, DONNA J (NP)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:J
Last Name:HEADRICK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3400 CALLOWAY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312
Mailing Address - Country:US
Mailing Address - Phone:661-410-7546
Mailing Address - Fax:661-410-7547
Practice Address - Street 1:3400 CALLOWAY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312
Practice Address - Country:US
Practice Address - Phone:661-410-7546
Practice Address - Fax:661-410-7547
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA499144363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner