Provider Demographics
NPI:1497290803
Name:HEALTH EDUCATION AND RESOURCE TECHNOLOGY
Entity Type:Organization
Organization Name:HEALTH EDUCATION AND RESOURCE TECHNOLOGY
Other - Org Name:HEART CLINIC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MERCIER
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:530-244-2213
Mailing Address - Street 1:850 INDUSTRIAL ST
Mailing Address - Street 2:100
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0501
Mailing Address - Country:US
Mailing Address - Phone:530-244-2213
Mailing Address - Fax:530-244-2491
Practice Address - Street 1:850 INDUSTRIAL ST
Practice Address - Street 2:100
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0501
Practice Address - Country:US
Practice Address - Phone:530-244-2213
Practice Address - Fax:530-244-2491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942457676Medicare UPIN