Provider Demographics
NPI:1750195400
Name:MYERS, HEIDI
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:MYERS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 MARSHALL CT NW UNIT 7
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4142
Mailing Address - Country:US
Mailing Address - Phone:225-287-2398
Mailing Address - Fax:
Practice Address - Street 1:124 CRISTOBOL AVE
Practice Address - Street 2:#503
Practice Address - City:MARY ESTHER
Practice Address - State:FL
Practice Address - Zip Code:32569
Practice Address - Country:US
Practice Address - Phone:225-287-2398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-04
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9480322163WP0808X
FLRBT1229827106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health