Provider Demographics
NPI:1043301930
Name:HEISTAND, KARI CASE (MD)
Entity type:Individual
Prefix:DR
First Name:KARI
Middle Name:CASE
Last Name:HEISTAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 TWINSVIEW CT
Mailing Address - Street 2:
Mailing Address - City:PORT LUDLOW
Mailing Address - State:WA
Mailing Address - Zip Code:98365-9219
Mailing Address - Country:US
Mailing Address - Phone:360-621-9475
Mailing Address - Fax:
Practice Address - Street 1:210 POLK ST STE 4A
Practice Address - Street 2:
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368-6739
Practice Address - Country:US
Practice Address - Phone:360-385-9918
Practice Address - Fax:360-385-1496
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000455092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1871714857Medicaid
WAG8892268Medicare PIN