Provider Demographics
NPI:1114980042
Name:PRATT, HEIDI D (DO)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:D
Last Name:PRATT
Suffix:
Gender:F
Credentials:DO
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 728
Mailing Address - Street 2:
Mailing Address - City:WATER VALLEY
Mailing Address - State:MS
Mailing Address - Zip Code:38965-0728
Mailing Address - Country:US
Mailing Address - Phone:662-473-1311
Mailing Address - Fax:662-473-2489
Practice Address - Street 1:604 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WATER VALLEY
Practice Address - State:MS
Practice Address - Zip Code:38965-3468
Practice Address - Country:US
Practice Address - Phone:662-473-1311
Practice Address - Fax:662-473-2489
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9122207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL273887200Medicaid
MS06075268Medicaid
FLI45196Medicare UPIN
FLU6331ZMedicare ID - Type Unspecified