Provider Demographics
NPI:1598710006
Name:MORELAND, HEATHER (CRNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:MORELAND
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4145 CARMICHAEL ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2801
Mailing Address - Country:US
Mailing Address - Phone:334-273-7000
Mailing Address - Fax:334-286-2386
Practice Address - Street 1:4145 CARMICHAEL ROAD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2801
Practice Address - Country:US
Practice Address - Phone:334-273-7000
Practice Address - Fax:334-286-2386
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1084170363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner