Provider Demographics
NPI:1346719291
Name:HEATON, BRANDY DAWN (FNP-C APRN)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:DAWN
Last Name:HEATON
Suffix:
Gender:F
Credentials:FNP-C APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44308
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87174-4308
Mailing Address - Country:US
Mailing Address - Phone:505-315-3541
Mailing Address - Fax:505-445-4904
Practice Address - Street 1:4801 MCMAHON BLVD NW STE 245
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5478
Practice Address - Country:US
Practice Address - Phone:505-315-3541
Practice Address - Fax:505-445-4904
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP54278363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRN81953OtherRN LICENSE
NMCS00226579OtherNM CONTROLLED SUBSTANCE
NMCNP54278OtherCNP LICENSE
NMMH5047988OtherDEA LICENSE