Healthcare Provider Details

I. General information

NPI: 1285883306
Provider Name (Legal Business Name): HEATHER D ELEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER DAWN BETHKE LVN

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE SE
ROANOKE VA
24014-1838
US

IV. Provider business mailing address

213 S JEFFERSON ST STE 1006
ROANOKE VA
24011-1713
US

V. Phone/Fax

Practice location:
  • Phone: 540-981-7000
  • Fax: 540-981-8429
Mailing address:
  • Phone: 540-224-5516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP034473
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024179500
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: