Provider Demographics
NPI:1366404303
Name:VERMETTE, HEIDI SHANNON (MD)
Entity type:Individual
Prefix:DR
First Name:HEIDI
Middle Name:SHANNON
Last Name:VERMETTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEIDI
Other - Middle Name:SHANNON
Other - Last Name:SCHORER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1012 KING RICHARD BLVD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604
Mailing Address - Country:US
Mailing Address - Phone:423-943-5150
Mailing Address - Fax:214-857-0917
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:214-857-0805
Practice Address - Fax:214-857-0917
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL82222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176280901Medicaid
G84166Medicare UPIN