Provider Demographics
NPI:1265794564
Name:GLOVER, HEATHER LEANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEANN
Last Name:GLOVER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LEANN
Other - Last Name:HUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9146 HIGHWAY 63 N
Mailing Address - Street 2:
Mailing Address - City:BONO
Mailing Address - State:AR
Mailing Address - Zip Code:72416-8153
Mailing Address - Country:US
Mailing Address - Phone:870-930-9990
Mailing Address - Fax:870-930-9992
Practice Address - Street 1:9146 HIGHWAY 63 N
Practice Address - Street 2:
Practice Address - City:BONO
Practice Address - State:AR
Practice Address - Zip Code:72416
Practice Address - Country:US
Practice Address - Phone:870-930-9990
Practice Address - Fax:870-930-9992
Is Sole Proprietor?:No
Enumeration Date:2012-06-12
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003298363LF0000X
ARA03298 ANP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily