Provider Demographics
NPI:1306427331
Name:BLUE, HEATHER MARIE (PMHNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:BLUE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 TINGLER RD W
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-9205
Mailing Address - Country:US
Mailing Address - Phone:765-977-6864
Mailing Address - Fax:
Practice Address - Street 1:831 DILLON DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-8048
Practice Address - Country:US
Practice Address - Phone:765-983-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28168341A163W00000X
IN71011399A363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse