Healthcare Provider Details

I. General information

NPI: 1205547205
Provider Name (Legal Business Name): HEATHER NANCY MOON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 W FAIRVIEW AVE
HOMER AK
99603-7032
US

IV. Provider business mailing address

4300 BARTLETT ST
HOMER AK
99603-7000
US

V. Phone/Fax

Practice location:
  • Phone: 907-435-3070
  • Fax: 855-202-9120
Mailing address:
  • Phone: 907-235-8101
  • Fax: 855-202-9120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number200972
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number200972
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: