Provider Demographics
NPI:1073397840
Name:BOALS, HEATHER JONES (FNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JONES
Last Name:BOALS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:458 OLD OAK LN
Mailing Address - Street 2:
Mailing Address - City:COLLIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38017-1720
Mailing Address - Country:US
Mailing Address - Phone:901-275-0630
Mailing Address - Fax:
Practice Address - Street 1:458 OLD OAK LN
Practice Address - Street 2:
Practice Address - City:COLLIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38017-1720
Practice Address - Country:US
Practice Address - Phone:901-275-0630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000030186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily