Provider Demographics
NPI:1245318666
Name:MASON, HEATHER NICOLE (APRN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICOLE
Last Name:MASON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:NICOLE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:438 ADAM SHEPHERD PKWY
Practice Address - Street 2:SUITE 1
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6640
Practice Address - Country:US
Practice Address - Phone:502-543-1055
Practice Address - Fax:502-543-1052
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005033363L00000X
KY5033P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY114762OtherSIHO - NCMA
KY000000765758OtherANTHEM-NCMA
KY50037753OtherPASSPORT - NCMA
KY000000573918OtherANTHEM
IN201150490Medicaid
KY7100062660Medicaid
KY00546114Medicare Oscar/Certification
KY000000765758OtherANTHEM-NCMA
KY50037753OtherPASSPORT - NCMA