Healthcare Provider Details

I. General information

NPI: 1093918997
Provider Name (Legal Business Name): HEATHER A WHITE A.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2519 COLLEGE AVE
CONWAY AR
72034-6135
US

IV. Provider business mailing address

2519 COLLEGE AVE
CONWAY AR
72034-6135
US

V. Phone/Fax

Practice location:
  • Phone: 501-450-3920
  • Fax: 501-450-7718
Mailing address:
  • Phone: 501-450-3920
  • Fax: 501-450-7718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA002990
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberA02990
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: