Provider Demographics
NPI:1467147827
Name:FRIEND, HEATHER DANIELLE (APRN, FNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DANIELLE
Last Name:FRIEND
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W 3RD ST STE 3
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65711-1600
Mailing Address - Country:US
Mailing Address - Phone:417-926-3743
Mailing Address - Fax:
Practice Address - Street 1:205 W 3RD ST STE 3
Practice Address - Street 2:
Practice Address - City:MOUNTAIN GROVE
Practice Address - State:MO
Practice Address - Zip Code:65711-1600
Practice Address - Country:US
Practice Address - Phone:417-926-3743
Practice Address - Fax:417-926-7625
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOF12220595363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily