Provider Demographics
NPI:1871640417
Name:HEAVNER, ANGELA CAROL (CRNP)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:CAROL
Last Name:HEAVNER
Suffix:
Gender:F
Credentials:CRNP
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 1972
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-5972
Mailing Address - Country:US
Mailing Address - Phone:614-226-8031
Mailing Address - Fax:
Practice Address - Street 1:17273 STATE ROUTE 104 BLDG 27
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9718
Practice Address - Country:US
Practice Address - Phone:740-773-1141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR168466363L00000X
OHCOA.08278-NP363LA2200X
NC5003017363LA2200X
NC249462363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1871640417Medicaid
SCNP2380Medicaid
NCNCC668BMedicare PIN
NC1871640417Medicaid
NCNCC668AMedicare PIN