Provider Demographics
NPI:1760999700
Name:O'HEARN, HEATHER KINLAW (RD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:KINLAW
Last Name:O'HEARN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100325
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0325
Mailing Address - Country:US
Mailing Address - Phone:352-265-0400
Mailing Address - Fax:352-265-1071
Practice Address - Street 1:PO BOX 100325
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0325
Practice Address - Country:US
Practice Address - Phone:352-265-0400
Practice Address - Fax:352-265-1071
Is Sole Proprietor?:No
Enumeration Date:2017-12-29
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL005281133V00000X
FLND11875133V00000X
NC86059263133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered