Provider Demographics
NPI:1750162913
Name:MEWBORN, HEATHER GALLION (FNP-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:GALLION
Last Name:MEWBORN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 CHANNEL MARKER LOOP
Mailing Address - Street 2:
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-7728
Mailing Address - Country:US
Mailing Address - Phone:252-469-6776
Mailing Address - Fax:
Practice Address - Street 1:2145 COUNTRY CLUB RD STE 500
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-2404
Practice Address - Country:US
Practice Address - Phone:910-353-0565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily