Healthcare Provider Details

I. General information

NPI: 1982233136
Provider Name (Legal Business Name): NICOLE ASHLEE HEELY CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2020
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 BREMO RD STE 306
RICHMOND VA
23226-1934
US

IV. Provider business mailing address

6511 PARK AVE
RICHMOND VA
23226-3031
US

V. Phone/Fax

Practice location:
  • Phone: 804-281-8303
  • Fax:
Mailing address:
  • Phone: 210-243-3220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024179147
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: