Healthcare Provider Details

I. General information

NPI: 1679491112
Provider Name (Legal Business Name): HEATHER RAE PAYERCHIN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W 2ND AVE
LATROBE PA
15650-1068
US

IV. Provider business mailing address

321 GARDEN CENTER CT
NORTH HUNTINGDON PA
15642-8533
US

V. Phone/Fax

Practice location:
  • Phone: 724-537-1000
  • Fax:
Mailing address:
  • Phone: 412-523-4820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP036365
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: