Provider Demographics
NPI:1659448868
Name:TERRY, HEATHER LEIGH (APN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEIGH
Last Name:TERRY
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LEIGH
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12 E APPLEBY RD STE 102
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-3928
Mailing Address - Country:US
Mailing Address - Phone:479-463-7902
Mailing Address - Fax:479-463-5345
Practice Address - Street 1:12 E APPLEBY RD STE 101
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-3928
Practice Address - Country:US
Practice Address - Phone:479-463-4444
Practice Address - Fax:479-463-4499
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA001584363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR145544758Medicaid
5W610OtherBCBS
71-0781138OtherMERCY
6973035OtherCIGNA
710781138028OtherTRICARE
110178813Medicare PIN
6973035OtherCIGNA
AR145544758Medicaid