MEDICARE: MRS. HEATHER LAUREN RICHARDSON FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN0000020762	TN

General Provider Information

NPI Number	:	1629510284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEATHER LAUREN RICHARDSON FNP-BC

Provider Business Mailing Address
First Line	:	103 JORDAN DR
Second Line	:	SUITE 3
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-6715
Country	:	US
Telephone Number	:	423-499-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 JORDAN DR
Second Line	:	SUITE 3
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-6715
Country	:	US
Telephone Number	:	423-499-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2016
Last Update Date	:	11/14/2016

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Directions to “ MRS. HEATHER LAUREN RICHARDSON FNP-BC” Practice Location

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