Provider Demographics
NPI:1811931553
Name:HEITMAN, ELIZABETH D (APN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:D
Last Name:HEITMAN
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:DARBY
Other - Last Name:FLYNN-HEITMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1727 KIRBY PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120
Mailing Address - Country:US
Mailing Address - Phone:901-767-3810
Mailing Address - Fax:901-682-2920
Practice Address - Street 1:3964 GOODMAN RD E STE 131
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-8762
Practice Address - Country:US
Practice Address - Phone:662-856-8440
Practice Address - Fax:662-350-7032
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905305363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q70149Medicare UPIN
3643392Medicare ID - Type Unspecified