Provider Demographics
NPI:1194211748
Name:BADGER, HEATHER NICOLE (NP-C)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:NICOLE
Last Name:BADGER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1130 RACE RD
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-9528
Mailing Address - Country:US
Mailing Address - Phone:360-929-0021
Mailing Address - Fax:208-262-2390
Practice Address - Street 1:1130 RACE RD
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-9528
Practice Address - Country:US
Practice Address - Phone:360-929-0021
Practice Address - Fax:208-262-2390
Is Sole Proprietor?:No
Enumeration Date:2018-07-06
Last Update Date:2022-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID69887363L00000X
WAAP60867565363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1194211748Medicaid