Provider Demographics
NPI:1689331258
Name:RUSSELL, HEATHER LEIGH (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LEIGH
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 WOODED ACRES CIR
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:AR
Mailing Address - Zip Code:72120-4088
Mailing Address - Country:US
Mailing Address - Phone:501-258-0786
Mailing Address - Fax:
Practice Address - Street 1:408 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-7534
Practice Address - Country:US
Practice Address - Phone:501-847-2835
Practice Address - Fax:501-847-6809
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR217990363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily