Provider Demographics
NPI:1952848178
Name:HEFFNER, MELISSA DAWN (NP)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:DAWN
Last Name:HEFFNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-6264
Mailing Address - Country:US
Mailing Address - Phone:812-748-3412
Mailing Address - Fax:812-748-3413
Practice Address - Street 1:806 JACKSON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-6264
Practice Address - Country:US
Practice Address - Phone:812-748-3412
Practice Address - Fax:812-748-3413
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007171A363LF0000X
IN28210233A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300015057Medicaid