Healthcare Provider Details

I. General information

NPI: 1356703177
Provider Name (Legal Business Name): ANDREA LEIGH HEIFNER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 DANNY THOMAS PL
MEMPHIS TN
38105-3678
US

IV. Provider business mailing address

262 DANNY THOMAS PL # MS 515
MEMPHIS TN
38105-3678
US

V. Phone/Fax

Practice location:
  • Phone: 901-595-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax: 713-486-0989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number71074
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT1381
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number321882
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberT1381
License Number StateTX
# 5
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number71074
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: