Provider Demographics
NPI:1982944344
Name:HEIDI READ FNP-BC PLLC
Entity Type:Organization
Organization Name:HEIDI READ FNP-BC PLLC
Other - Org Name:READ FAMILY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FAMILYL NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:READ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:928-775-6312
Mailing Address - Street 1:PO BOX 1290
Mailing Address - Street 2:
Mailing Address - City:CHINO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86323-1290
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8196 E FLORENTINE RD STE B1
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-8485
Practice Address - Country:US
Practice Address - Phone:928-775-6312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-22
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP 4585363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ728097Medicaid