Healthcare Provider Details

I. General information

NPI: 1356773196
Provider Name (Legal Business Name): HEATHER ANN DAILEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2013
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14395 STATE ROUTE 93
JACKSON OH
45640-9798
US

IV. Provider business mailing address

PO BOX 1595
ASHLAND KY
41105-1595
US

V. Phone/Fax

Practice location:
  • Phone: 740-288-7682
  • Fax:
Mailing address:
  • Phone: 606-408-6200
  • Fax: 606-408-6212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0713666
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: