Provider Demographics
NPI:1629510284
Name:RICHARDSON, HEATHER LAUREN (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LAUREN
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 JORDAN DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-6715
Mailing Address - Country:US
Mailing Address - Phone:423-499-6400
Mailing Address - Fax:
Practice Address - Street 1:103 JORDAN DR
Practice Address - Street 2:SUITE 3
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-6715
Practice Address - Country:US
Practice Address - Phone:423-499-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000020762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily