Provider Demographics
NPI:1861428716
Name:HARDEN, HEATHER JOHNSON (CFNP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:JOHNSON
Last Name:HARDEN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815A SMYLIE RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MS
Mailing Address - Zip Code:39645-8249
Mailing Address - Country:US
Mailing Address - Phone:601-657-1277
Mailing Address - Fax:
Practice Address - Street 1:138 CLINIC DRIVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MS
Practice Address - Zip Code:39645
Practice Address - Country:US
Practice Address - Phone:601-657-8091
Practice Address - Fax:601-657-8873
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR862562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02323888Medicaid
MSQ64957Medicare UPIN
MS02323888Medicaid
500002075Medicare PIN