Provider Demographics
NPI:1396712287
Name:BASTEL, HEATHER ELAINE (APN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELAINE
Last Name:BASTEL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 W. KINGSHIGHWAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-2644
Mailing Address - Country:US
Mailing Address - Phone:870-236-7272
Mailing Address - Fax:870-236-7275
Practice Address - Street 1:2709 W. KINGSHIGHWAY
Practice Address - Street 2:SUITE 6
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-2644
Practice Address - Country:US
Practice Address - Phone:870-236-7272
Practice Address - Fax:870-236-7275
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01117363L00000X
ARA03196ANP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y408Medicare ID - Type Unspecified
ARQ47111Medicare UPIN
AR5Y408Medicare PIN