Provider Demographics
NPI:1295168565
Name:HERON, BETHANY LEIGH (CRNP)
Entity type:Individual
Prefix:MRS
First Name:BETHANY
Middle Name:LEIGH
Last Name:HERON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 4TH AVE S # CPP230
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1723
Mailing Address - Country:US
Mailing Address - Phone:205-638-9107
Mailing Address - Fax:205-638-9821
Practice Address - Street 1:1601 4TH AVE S # CPP230
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1723
Practice Address - Country:US
Practice Address - Phone:205-638-9107
Practice Address - Fax:205-638-9821
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-066424363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily