Healthcare Provider Details

I. General information

NPI: 1225487143
Provider Name (Legal Business Name): HEATHER CHEANEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W PINE ST
FARMINGTON MO
63640-1439
US

IV. Provider business mailing address

PO BOX 14369
SAINT LOUIS MO
63178-4369
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-8888
  • Fax:
Mailing address:
  • Phone: 314-729-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number155768
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: