Provider Demographics
NPI:1972930204
Name:DEMAREE, HEATHER MAE (PAC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MAE
Last Name:DEMAREE
Suffix:
Gender:
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:JELLICO
Mailing Address - State:TN
Mailing Address - Zip Code:37762-0447
Mailing Address - Country:US
Mailing Address - Phone:423-784-7269
Mailing Address - Fax:423-784-3708
Practice Address - Street 1:131 HOSPITAL LN
Practice Address - Street 2:
Practice Address - City:JELLICO
Practice Address - State:TN
Practice Address - Zip Code:37762-4404
Practice Address - Country:US
Practice Address - Phone:423-784-7269
Practice Address - Fax:423-784-3708
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN2306363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical