MEDICARE: HEATHER MARIE SCRIMPSHIRE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN209942	GA

General Provider Information

NPI Number	:	1306484043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MARIE SCRIMPSHIRE NP

Provider Business Mailing Address
First Line	:	250 MARTIN LUTHER KING JR BLVD
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31201-3490
Country	:	US
Telephone Number	:	478-301-4111
Fax Number	:

Provider Business Practice Location Address
First Line	:	138 N COLLEGE ST
Second Line	:
City	:	HAMILTON
State	:	GA
Zip	:	31811-6031
Country	:	US
Telephone Number	:	762-267-0309
Fax Number	:	762-267-0350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2019
Last Update Date	:	07/11/2023

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