Provider Demographics
NPI:1821637216
Name:HAVENS, HEATHER GAYE (DNP, PPCNP, CNS)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:GAYE
Last Name:HAVENS
Suffix:
Gender:F
Credentials:DNP, PPCNP, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
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Mailing Address - Street 1:820 BELLE MEADE DR
Mailing Address - Street 2:
Mailing Address - City:EADS
Mailing Address - State:TN
Mailing Address - Zip Code:38028-3524
Mailing Address - Country:US
Mailing Address - Phone:901-484-9234
Mailing Address - Fax:901-595-2565
Practice Address - Street 1:262 DANNY THOMAS PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-2565
Practice Address - Fax:901-595-4046
Is Sole Proprietor?:No
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7753363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics