Basic Information
| Provider Information | |||||||||
| NPI: | 1306236377 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOYA | ||||||||
| FirstName: | HEATHER | ||||||||
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| Credential: | APRN, CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 106 MIMOSA ST | ||||||||
| Address2: | |||||||||
| City: | AMITE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704222136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9852472411 | ||||||||
| FaxNumber: | 9852472415 | ||||||||
| Practice Location | |||||||||
| Address1: | 27124 HIGHWAY 42 | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256835292 | ||||||||
| FaxNumber: | 2256831310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2015 | ||||||||
| LastUpdateDate: | 04/01/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | AP08164 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 2382217 | 05 | LA | MEDICAID |