Healthcare Provider Details

I. General information

NPI: 1184125569
Provider Name (Legal Business Name): HEATHER R MCDANIEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2018
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 MEDICAL PLAZA WAY
CLARKSVILLE IN
47129-9204
US

IV. Provider business mailing address

4601 MEDICAL PLAZA WAY
CLARKSVILLE IN
47129-9204
US

V. Phone/Fax

Practice location:
  • Phone: 930-203-1947
  • Fax:
Mailing address:
  • Phone: 930-203-1947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3012122
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: