Provider Demographics
NPI:1588836746
Name:EGAN, HEATHER LEIGH
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEIGH
Last Name:EGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:BALLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15110 OLD TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FISHERVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40023-8758
Mailing Address - Country:US
Mailing Address - Phone:502-266-6268
Mailing Address - Fax:
Practice Address - Street 1:15110 OLD TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:FISHERVILLE
Practice Address - State:KY
Practice Address - Zip Code:40023-8758
Practice Address - Country:US
Practice Address - Phone:502-266-6268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator