Provider Demographics
NPI:1346553575
Name:RICHARDSON, HEATHER (FNP-BC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1337
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-1337
Mailing Address - Country:US
Mailing Address - Phone:276-238-3566
Mailing Address - Fax:276-236-8780
Practice Address - Street 1:104 CRANBERRY RD STE 200A
Practice Address - Street 2:
Practice Address - City:GALAX
Practice Address - State:VA
Practice Address - Zip Code:24333-0009
Practice Address - Country:US
Practice Address - Phone:276-236-9953
Practice Address - Fax:276-236-6084
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168882363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily