Provider Demographics
NPI:1174165054
Name:FORD, HEATHER MARSHALL (APRN)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARSHALL
Last Name:FORD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BUFORD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-3365
Mailing Address - Country:US
Mailing Address - Phone:864-940-0523
Mailing Address - Fax:
Practice Address - Street 1:102 BUFORD AVE STE A
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-3365
Practice Address - Country:US
Practice Address - Phone:864-261-9506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-12
Last Update Date:2023-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23290363LP0808X
SC54-23290363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health