Provider Demographics
NPI:1437256443
Name:KOONTS, HEATHER LEIGH MCDANIEL (C-PNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEIGH MCDANIEL
Last Name:KOONTS
Suffix:
Gender:F
Credentials:C-PNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LEIGH
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:C-PNP
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:240 BROAD ST
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2930
Practice Address - Country:US
Practice Address - Phone:336-993-8333
Practice Address - Fax:336-993-5144
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC185514363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592715AMedicare PIN