MEDICARE: DR. CHARLISA HEYWARD DNP, FNP-C

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	363L00000X	Nurse Practitioner	95012553	CA

General Provider Information

NPI Number	:	1588218663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLISA HEYWARD DNP, FNP-C

Provider Business Mailing Address
First Line	:	12640 HESPERIA RD STE D
Second Line	:
City	:	VICTORVILLE
State	:	CA
Zip	:	92395-7753
Country	:	US
Telephone Number	:	760-684-4143
Fax Number	:	760-684-8111

Provider Business Practice Location Address
First Line	:	17450 MAIN ST STE D
Second Line	:
City	:	HESPERIA
State	:	CA
Zip	:	92345-6262
Country	:	US
Telephone Number	:	760-493-2929
Fax Number	:

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

Provider Enumeration Date	:	07/28/2019
Last Update Date	:	03/04/2026

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