Provider Demographics
NPI:1518596758
Name:HEATON, ELIZABETH LENA JEAN (APRN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:LENA JEAN
Last Name:HEATON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:502-350-5800
Mailing Address - Fax:502-350-5820
Practice Address - Street 1:4359 NEW SHEPHERDSVILLE RD UNIT 255
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-8004
Practice Address - Country:US
Practice Address - Phone:502-350-5800
Practice Address - Fax:502-350-5820
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-08
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014489363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100666810Medicaid