Provider Demographics
NPI:1164835146
Name:STORY, HEATHER
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:STORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1743 WATSON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3622
Mailing Address - Country:US
Mailing Address - Phone:478-328-9690
Mailing Address - Fax:
Practice Address - Street 1:1743 WATSON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3622
Practice Address - Country:US
Practice Address - Phone:478-328-9690
Practice Address - Fax:478-328-9692
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN149564363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF0614256OtherNP CERTIFICATION NUMBER
GARN149564OtherNURSE PRACTIONER NUMBER