Healthcare Provider Details

I. General information

NPI: 1710572508
Provider Name (Legal Business Name): HEATHER N HALE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER N GOMEZ

II. Dates (important events)

Enumeration Date: 03/04/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S GREEN RIVER RD STE 1
EVANSVILLE IN
47715-4104
US

IV. Provider business mailing address

3245 MOUNT MORIAH AVE STE 10
OWENSBORO KY
42303-7834
US

V. Phone/Fax

Practice location:
  • Phone: 812-901-5770
  • Fax: 812-379-8983
Mailing address:
  • Phone: 270-663-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71011061A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: