Healthcare Provider Details

I. General information

NPI: 1306356225
Provider Name (Legal Business Name): HEATHER LESLEY HARVILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER LESLEY DALTON

II. Dates (important events)

Enumeration Date: 10/05/2017
Last Update Date: 10/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7719 HIGHWAY 131
WASHBURN TN
37888-4055
US

IV. Provider business mailing address

6350 W ANDREW JOHNSON HWY
TALBOTT TN
37877-8605
US

V. Phone/Fax

Practice location:
  • Phone: 865-497-2591
  • Fax: 865-497-3803
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN155313
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: