Provider Demographics
NPI:1912174657
Name:CHAMPNEY, HEATHER NAOMI (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:NAOMI
Last Name:CHAMPNEY
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 1:117 E F ST
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTON
Mailing Address - State:TN
Mailing Address - Zip Code:37643-3253
Mailing Address - Country:US
Mailing Address - Phone:423-547-9355
Mailing Address - Fax:423-547-9356
Practice Address - Street 1:117 E F ST
Practice Address - Street 2:
Practice Address - City:ELIZABETHTON
Practice Address - State:TN
Practice Address - Zip Code:37643-3253
Practice Address - Country:US
Practice Address - Phone:423-547-9355
Practice Address - Fax:423-547-9356
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44805207P00000X
TNMD0000044805208000000X
TNMD44805208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514066Medicaid
VA1912174657Medicaid
TN103I377638Medicare PIN
TN1514066Medicaid