Provider Demographics
NPI:1790802809
Name:SPOON, HEATHER DEANN (APN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:DEANN
Last Name:SPOON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 N MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:STUTTGART
Mailing Address - State:AR
Mailing Address - Zip Code:72160-3274
Mailing Address - Country:US
Mailing Address - Phone:870-673-7211
Mailing Address - Fax:
Practice Address - Street 1:1609 N MEDICAL DR
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-3274
Practice Address - Country:US
Practice Address - Phone:870-673-7211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA02985 ANP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR201478729Medicaid
AR100907002Medicaid
AR201477729Medicaid
AR201479729Medicaid
AR201481729Medicaid
AR129735729Medicaid
AR129734729Medicaid
AR136428729Medicaid
AR201482729Medicaid
AR136428729Medicaid
AR043456Medicare Oscar/Certification
AR201479729Medicaid
AR201477729Medicaid
AR201478729Medicaid
AR201481729Medicaid