1215304019 NPI number — MS. HEATHER CRYSTAL SEARGEANT BSP

Table of content: MS. HEATHER CRYSTAL SEARGEANT BSP (NPI 1215304019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215304019 NPI number — MS. HEATHER CRYSTAL SEARGEANT BSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEARGEANT
Provider First Name:
HEATHER
Provider Middle Name:
CRYSTAL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BSP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MINER
Provider Other First Name:
HEATHER
Provider Other Middle Name:
CRYSTAL
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215304019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12525 SE EASTHAMPTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLACKAMAS
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97015-8622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-841-1142
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
845 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLITS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95490-3915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-456-1790
Provider Business Practice Location Address Fax Number:
707-456-1794
Provider Enumeration Date:
08/27/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P0018X , with the licence number:  RPH-00017866 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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