Provider Demographics
NPI:1316591126
Name:SIMON, HEATHER JAET (WHNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:JAET
Last Name:SIMON
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 1:606 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-3358
Mailing Address - Country:US
Mailing Address - Phone:985-845-1985
Mailing Address - Fax:985-256-5687
Practice Address - Street 1:113 BREWSTER RD
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-9579
Practice Address - Country:US
Practice Address - Phone:985-845-1985
Practice Address - Fax:985-256-5687
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204296363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health