Provider Demographics
NPI:1639636772
Name:CLEVINGER, HEATH (FNP)
Entity Type:Individual
Prefix:MR
First Name:HEATH
Middle Name:
Last Name:CLEVINGER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5260 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-8225
Mailing Address - Country:US
Mailing Address - Phone:276-971-5072
Mailing Address - Fax:
Practice Address - Street 1:5260 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:CEDAR BLUFF
Practice Address - State:VA
Practice Address - Zip Code:24609-8225
Practice Address - Country:US
Practice Address - Phone:276-971-5072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0024177296363L00000X
VA0024177296207Q00000X
VA00241177296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily