Provider Demographics
NPI:1962813105
Name:ADAMS, HEATHER SMITH (NP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:SMITH
Last Name:ADAMS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:RACHELLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 DR MICHAEL DEBAKEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-5724
Mailing Address - Country:US
Mailing Address - Phone:337-312-8360
Mailing Address - Fax:337-312-6708
Practice Address - Street 1:501 DR MICHAEL DEBAKEY DR
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-5724
Practice Address - Country:US
Practice Address - Phone:337-312-8328
Practice Address - Fax:337-433-2031
Is Sole Proprietor?:No
Enumeration Date:2014-05-09
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2366998Medicaid
LA2366998Medicaid