Provider Demographics
NPI:1174715825
Name:HEUSTIS, KAREN SUE (FNPC)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:HEUSTIS
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:SUE
Other - Last Name:EDWARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNPC
Mailing Address - Street 1:19705 VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-9608
Mailing Address - Country:US
Mailing Address - Phone:530-999-3706
Mailing Address - Fax:
Practice Address - Street 1:1245 E HERNDON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3235
Practice Address - Country:US
Practice Address - Phone:559-664-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14928363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54428OtherPUBLIC HEALTH
CA13996544OtherCAQH
CARHM53832HMedicaid
CARHM55382OtherRURAL HEALTH
CA14928OtherBRN
CA2005007373OtherANCC
CA5145855124OtherDOT