Provider Demographics
NPI:1184255226
Name:ABERNATHY, HEATHER DIANE
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:DIANE
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:DIANE
Other - Last Name:SULTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN FNP-C
Mailing Address - Street 1:1501 ASPEN ACRES DR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72019-6376
Mailing Address - Country:US
Mailing Address - Phone:501-844-1983
Mailing Address - Fax:
Practice Address - Street 1:1501 ASPEN ACRES DR
Practice Address - Street 2:
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72019-6376
Practice Address - Country:US
Practice Address - Phone:501-844-1983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR123792363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR123792OtherAPRN-CNP