Provider Demographics
NPI:1548252984
Name:RUPE, HEATHER DAWN (DO)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:DAWN
Last Name:RUPE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 CAROTHERS PKWY
Mailing Address - Street 2:STE 208
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5914
Mailing Address - Country:US
Mailing Address - Phone:615-778-0010
Mailing Address - Fax:615-778-0715
Practice Address - Street 1:4323 CAROTHERS PKWY
Practice Address - Street 2:STE 208
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5914
Practice Address - Country:US
Practice Address - Phone:615-778-0010
Practice Address - Fax:615-778-0715
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TND01676207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3730036Medicaid
TN3319324Medicare PIN
I30554Medicare UPIN