Provider Demographics
NPI:1598280810
Name:DANIELS, HEATHER (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:
Last Name:DANIELS
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:WISBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:NEW LLANO
Mailing Address - State:LA
Mailing Address - Zip Code:71461
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:919 S. 10TH ST.
Practice Address - Street 2:
Practice Address - City:LEESVILLE
Practice Address - State:LA
Practice Address - Zip Code:71446
Practice Address - Country:US
Practice Address - Phone:337-404-4106
Practice Address - Fax:337-404-4108
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09432363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2479881Medicaid