Healthcare Provider Details

I. General information

NPI: 1740057074
Provider Name (Legal Business Name): HEATHER PROCTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2023
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1273 E HIGHWAY 64
COAL HILL AR
72832-8862
US

IV. Provider business mailing address

1273 E HIGHWAY 64
COAL HILL AR
72832-8862
US

V. Phone/Fax

Practice location:
  • Phone: 479-279-7676
  • Fax: 479-279-7678
Mailing address:
  • Phone: 479-279-7676
  • Fax: 479-279-7678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number213994
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: