Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 23974 | TN |
NPI | 1033358379 |
---|---|
Provider Name | Christel Amber Heacker |
First Address | Knoxville, TN 37909-2441 |
Second Address | Knoxville, TN 37909-2441 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2009 |
Last Update Date | 23/04/2018 |