Provider Demographics
NPI:1215289590
Name:GRANT, HEATHER ANDERSON (APRN FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANDERSON
Last Name:GRANT
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ELIZABETH
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 602658
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2658
Mailing Address - Country:US
Mailing Address - Phone:336-716-2011
Mailing Address - Fax:
Practice Address - Street 1:171 W WILKES MEDICAL CENTER RD
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:NC
Practice Address - Zip Code:28624-8925
Practice Address - Country:US
Practice Address - Phone:336-973-7050
Practice Address - Fax:336-973-9370
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005840363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCA970AOtherMEDICARE PTAN INDIVIDUAL, UNDER WILKES PHYSICIAN NETWORK