Provider Demographics
NPI:1528658408
Name:WILSON, HEATHER MICHELLE (DPP LIFESTYLE COACH)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MICHELLE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DPP LIFESTYLE COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 HIGHWAY 172
Mailing Address - Street 2:
Mailing Address - City:WILMAR
Mailing Address - State:AR
Mailing Address - Zip Code:71675-8915
Mailing Address - Country:US
Mailing Address - Phone:870-308-1037
Mailing Address - Fax:
Practice Address - Street 1:778 SCOGIN DR
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-5729
Practice Address - Country:US
Practice Address - Phone:870-460-2411
Practice Address - Fax:870-460-3597
Is Sole Proprietor?:No
Enumeration Date:2021-01-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator