Provider Demographics
NPI:1801575691
Name:HAMM, HEATHER NICOLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICOLE
Last Name:HAMM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:851 E 5TH ST STE 108
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-3128
Mailing Address - Country:US
Mailing Address - Phone:636-861-7870
Mailing Address - Fax:
Practice Address - Street 1:851 E 5TH ST STE 108
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-3128
Practice Address - Country:US
Practice Address - Phone:636-861-7870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025052363LP2300X
MO2024015272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care