Provider Demographics
NPI:1356677850
Name:SMOOT, HEIDI ANGELA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:ANGELA
Last Name:SMOOT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CLEVELAND AVENUE, SUITE 14
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24112
Mailing Address - Country:US
Mailing Address - Phone:276-632-9714
Mailing Address - Fax:276-632-0620
Practice Address - Street 1:15 CLEVELAND AVENUE, SUITE 14
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24112
Practice Address - Country:US
Practice Address - Phone:276-632-9714
Practice Address - Fax:276-632-0620
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168519363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care