Provider Demographics
NPI:1104423383
Name:DAVIS, HEATHER NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICOLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 TREUHAFT BLVD STE 8
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7361
Mailing Address - Country:US
Mailing Address - Phone:606-277-0173
Mailing Address - Fax:606-277-0045
Practice Address - Street 1:215 TREUHAFT BLVD STE 8
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7361
Practice Address - Country:US
Practice Address - Phone:606-277-0173
Practice Address - Fax:606-277-0045
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily