Provider Demographics
NPI:1396467742
Name:HEIDERMAN, HAILEY R (APRN)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:R
Last Name:HEIDERMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HAILEY
Other - Middle Name:R
Other - Last Name:L'HEUREUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 PINE ST NW STE B
Mailing Address - Street 2:
Mailing Address - City:HARTSELLE
Mailing Address - State:AL
Mailing Address - Zip Code:35640-2339
Mailing Address - Country:US
Mailing Address - Phone:256-773-5469
Mailing Address - Fax:
Practice Address - Street 1:301 PINE ST NW STE B
Practice Address - Street 2:
Practice Address - City:HARTSELLE
Practice Address - State:AL
Practice Address - Zip Code:35640-2339
Practice Address - Country:US
Practice Address - Phone:256-773-5469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-199457363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily