Provider Demographics
NPI:1275619587
Name:HEATH, CATHY J (WHNP)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:J
Last Name:HEATH
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-3391
Mailing Address - Country:US
Mailing Address - Phone:812-523-3700
Mailing Address - Fax:812-524-2946
Practice Address - Street 1:1425 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-3391
Practice Address - Country:US
Practice Address - Phone:812-523-3700
Practice Address - Fax:812-524-2946
Is Sole Proprietor?:No
Enumeration Date:2006-10-29
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002376A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN25640Medicare PIN