Provider Demographics
NPI:1841281102
Name:HEAVNER, TERESA ANN (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:ANN
Last Name:HEAVNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:
Mailing Address - City:HAYESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28904-1309
Mailing Address - Country:US
Mailing Address - Phone:828-389-6383
Mailing Address - Fax:828-389-2322
Practice Address - Street 1:241 CHURCH ST
Practice Address - Street 2:
Practice Address - City:HAYESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28904-9688
Practice Address - Country:US
Practice Address - Phone:828-389-6383
Practice Address - Fax:828-389-2322
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC38971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8940888Medicaid
NC8940888Medicaid
NCE60533Medicare UPIN