Provider Demographics
NPI:1548753304
Name:BEAKLEY, HEATHER LUDWIG (FNP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LUDWIG
Last Name:BEAKLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 MCCALLIE AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3209
Mailing Address - Country:US
Mailing Address - Phone:235-086-7334
Mailing Address - Fax:
Practice Address - Street 1:2339 MCCALLIE AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3209
Practice Address - Country:US
Practice Address - Phone:235-086-7334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26251363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN26251OtherMEDICAL LICENSE