Provider Demographics
NPI:1124308192
Name:STEVENS, HEIDI (ACNP-BC)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:STEVENS
Suffix:
Gender:
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:
Other - Last Name:SEXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP-BC
Mailing Address - Street 1:1208 CHOCTAW TRL
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7410
Mailing Address - Country:US
Mailing Address - Phone:615-645-3031
Mailing Address - Fax:615-678-5676
Practice Address - Street 1:1208 CHOCTAW TRL
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7410
Practice Address - Country:US
Practice Address - Phone:615-645-3031
Practice Address - Fax:615-678-5676
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-008948363LA2100X
TN10447699363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$001Medicaid
IL$$$$$$$$$001Medicaid