Healthcare Provider Details

I. General information

NPI: 1770776619
Provider Name (Legal Business Name): HEATHER NICOLE SOPER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER BUCK CNM

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 BAYLOR ST
STAUNTON VA
24401-2075
US

IV. Provider business mailing address

905 BAYLOR ST
STAUNTON VA
24401-2075
US

V. Phone/Fax

Practice location:
  • Phone: 540-569-6745
  • Fax: 540-900-2414
Mailing address:
  • Phone: 540-569-6745
  • Fax: 540-900-2414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number0024173624
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF0016991
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number0024173624
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: