Provider Demographics
NPI:1568707370
Name:MOTT, HEATHER (APRN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MOTT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3452
Mailing Address - Country:US
Mailing Address - Phone:812-280-2080
Mailing Address - Fax:
Practice Address - Street 1:460 SPRING ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3452
Practice Address - Country:US
Practice Address - Phone:812-280-2080
Practice Address - Fax:812-206-1213
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1103245163W00000X
IN71010910A363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily