Provider Demographics
NPI:1982825428
Name:RATLIFF, HEATHER L, (DO)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:L,
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYNNE
Other - Last Name:VANCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:176 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:RAINELLE
Mailing Address - State:WV
Mailing Address - Zip Code:25962-1064
Mailing Address - Country:US
Mailing Address - Phone:304-438-6188
Mailing Address - Fax:304-438-6188
Practice Address - Street 1:289 DAWKINS DR
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:WV
Practice Address - Zip Code:24901-9674
Practice Address - Country:US
Practice Address - Phone:304-793-0005
Practice Address - Fax:540-283-4470
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS30391207RN0300X
AZ009847207RN0300X
WV2127207R00000X, 207RN0300X
TN3708207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS200000094Medicaid
AZ162742Medicaid
WV9054416OtherAETNA
WV2122486OtherHIGHMARK BLUE CROSS BLUE SHIELD
WV3810016079Medicaid