Provider Demographics
NPI:1144804022
Name:ENNIS, HEATHER ANN (APRN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:ENNIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANN
Other - Last Name:AUTRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-301-2092
Practice Address - Street 1:1601 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:ATKINS
Practice Address - State:AR
Practice Address - Zip Code:72823-3234
Practice Address - Country:US
Practice Address - Phone:479-480-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-07
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR214634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily