Provider Demographics
NPI:1780787705
Name:WIGHT, HEATHER STEVENS (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:STEVENS
Last Name:WIGHT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYNNE
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 15004
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37901-5004
Mailing Address - Country:US
Mailing Address - Phone:865-541-8895
Mailing Address - Fax:865-633-4808
Practice Address - Street 1:352 FOUNTAIN VIEW CIRCLE
Practice Address - Street 2:
Practice Address - City:ALCOA
Practice Address - State:TN
Practice Address - Zip Code:37701-1945
Practice Address - Country:US
Practice Address - Phone:865-982-0032
Practice Address - Fax:866-307-8963
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38469208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ007688Medicaid
TN4092676Medicaid
TN4092677OtherBCBS
H41050Medicare UPIN