Provider Demographics
NPI:1912320938
Name:STODDARD, HEIDI KATHERINE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:KATHERINE
Last Name:STODDARD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17914 JOHN CONNOR RD
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7661
Mailing Address - Country:US
Mailing Address - Phone:704-896-2181
Mailing Address - Fax:
Practice Address - Street 1:14230 HUNTERS RD
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7335
Practice Address - Country:US
Practice Address - Phone:704-947-6849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-27
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5009431363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health