Provider Demographics
NPI:1538681176
Name:SMITH, HEATHER ROBERTSON (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ROBERTSON
Last Name:SMITH
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 RED OAK TREE DR.
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71343-5573
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 SERIO BLVD.
Practice Address - Street 2:
Practice Address - City:FERRIDAY
Practice Address - State:LA
Practice Address - Zip Code:71334
Practice Address - Country:US
Practice Address - Phone:318-757-0210
Practice Address - Fax:318-757-9916
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902020363LF0000X
LAAP09354363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA606760Medicaid