Provider Demographics
NPI:1639429103
Name:FOXWORTHY, HEATHER D (ANP-BC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:D
Last Name:FOXWORTHY
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:D
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10330 N MERIDIAN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13450 N MERIDIAN ST
Practice Address - Street 2:SUITE 352
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1546
Practice Address - Country:US
Practice Address - Phone:317-582-9300
Practice Address - Fax:317-582-9307
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004123A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health