1306236377 NPI number — HEATHER MOYA APRN, CPNP

Table of content: HEATHER MOYA APRN, CPNP (NPI 1306236377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306236377 NPI number — HEATHER MOYA APRN, CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOYA
Provider First Name:
HEATHER
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306236377
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 MIMOSA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMITE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70422-2136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
985-247-2411
Provider Business Mailing Address Fax Number:
985-247-2415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27124 HIGHWAY 42
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
225-683-5292
Provider Business Practice Location Address Fax Number:
225-683-1310
Provider Enumeration Date:
01/29/2015

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: 363LP0200X , with the licence number:  AP08164 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2382217 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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