Provider Demographics
NPI:1235383381
Name:WILLIS, HEATHER LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:LYNN
Last Name:WILLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1202 NORTH CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3760
Mailing Address - Country:US
Mailing Address - Phone:828-322-4340
Mailing Address - Fax:828-323-8450
Practice Address - Street 1:1202 NORTH CENTER STREET
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3760
Practice Address - Country:US
Practice Address - Phone:828-322-4340
Practice Address - Fax:828-323-8450
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC201400625208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC201400625Medicaid