Provider Demographics
NPI:1609586692
Name:STEPHENS, HEATHER (PMHNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W CAL HILL SPUR
Mailing Address - Street 2:
Mailing Address - City:PINE KNOT
Mailing Address - State:KY
Mailing Address - Zip Code:42635-6242
Mailing Address - Country:US
Mailing Address - Phone:606-376-9355
Mailing Address - Fax:
Practice Address - Street 1:55 W CAL HILL SPUR
Practice Address - Street 2:
Practice Address - City:PINE KNOT
Practice Address - State:KY
Practice Address - Zip Code:42635-6242
Practice Address - Country:US
Practice Address - Phone:606-376-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018686363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health