1780787705 NPI number — HEATHER STEVENS WIGHT MD

Table of content: HEATHER STEVENS WIGHT MD (NPI 1780787705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780787705 NPI number — HEATHER STEVENS WIGHT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIGHT
Provider First Name:
HEATHER
Provider Middle Name:
STEVENS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STEVENS
Provider Other First Name:
HEATHER
Provider Other Middle Name:
LYNNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780787705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15004
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37901-5004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-541-8895
Provider Business Mailing Address Fax Number:
865-633-4808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
414 GREENBELT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37804-5702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-982-0032
Provider Business Practice Location Address Fax Number:
866-307-8963
Provider Enumeration Date:
09/06/2006

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: 208000000X , with the licence number:  38469 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q007688 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com