Provider Demographics
NPI:1518648120
Name:MARTIN, HEATHER BROOKE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:BROOKE
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1886 CHARLESTON RD
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:WV
Mailing Address - Zip Code:25276-8806
Mailing Address - Country:US
Mailing Address - Phone:130-453-1887
Mailing Address - Fax:
Practice Address - Street 1:1886 CHARLESTON RD
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:WV
Practice Address - Zip Code:25276-8806
Practice Address - Country:US
Practice Address - Phone:130-453-1887
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant