Provider Demographics
NPI:1205547205
Name:MOON, HEATHER NANCY (ARNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NANCY
Last Name:MOON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35671 KENAI SPUR HWY
Mailing Address - Street 2:
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7627
Mailing Address - Country:US
Mailing Address - Phone:907-260-1655
Mailing Address - Fax:855-854-8577
Practice Address - Street 1:35671 KENAI SPUR HWY
Practice Address - Street 2:
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669
Practice Address - Country:US
Practice Address - Phone:907-260-1655
Practice Address - Fax:855-854-8577
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK200972363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1735468Medicaid
AK200972OtherNURSE LICENSE APRN
AKNURR32396OtherNURSE LICENSE RN