Provider Demographics
NPI:1548445588
Name:SHULTZ, HEATHER RENEE (FNP)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:RENEE
Last Name:SHULTZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:RENEE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:305 N BELLWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-1120
Mailing Address - Country:US
Mailing Address - Phone:423-587-8300
Mailing Address - Fax:423-289-1609
Practice Address - Street 1:305 N BELLWOOD RD
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-1120
Practice Address - Country:US
Practice Address - Phone:423-587-8300
Practice Address - Fax:423-289-1609
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1512593Medicaid
TN3341864Medicaid