Provider Demographics
NPI:1679175327
Name:WESTBROOKS, HEAVEN (PA-C)
Entity type:Individual
Prefix:
First Name:HEAVEN
Middle Name:
Last Name:WESTBROOKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEAVEN
Other - Middle Name:
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2100 MACK BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-5622
Mailing Address - Country:US
Mailing Address - Phone:484-884-0617
Mailing Address - Fax:484-884-0628
Practice Address - Street 1:106 S CLAUDE A LORD BLVD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3639
Practice Address - Country:US
Practice Address - Phone:570-728-2424
Practice Address - Fax:570-728-2425
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA061796363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical