Provider Demographics
NPI:1619155686
Name:HARRIS, HEATHER M (ANP-BC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 YMCA PLAZA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-0939
Mailing Address - Country:US
Mailing Address - Phone:225-763-2403
Mailing Address - Fax:
Practice Address - Street 1:8235 YMCA PLAZA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-0939
Practice Address - Country:US
Practice Address - Phone:225-763-2403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-01
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP05305363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1034843Medicaid
LA3A575CQ60Medicare PIN