Healthcare Provider Details

I. General information

NPI: 1316630122
Provider Name (Legal Business Name): HEATHER PARKER MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 08/08/2023
Certification Date: 08/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 W MAIN ST STE 102
DOTHAN AL
36305-1306
US

IV. Provider business mailing address

4300 W MAIN ST STE 102
DOTHAN AL
36305-1306
US

V. Phone/Fax

Practice location:
  • Phone: 334-793-9564
  • Fax:
Mailing address:
  • Phone: 334-793-9564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1-161825
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: