Basic Information
| Provider Information | |||||||||
| NPI: | 1831515816 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SMALL | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | DAVENPORT | ||||||||
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| Credential: | PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1704 E ARLINGTON BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278587828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527564899 | ||||||||
| FaxNumber: | 2527565141 | ||||||||
| Practice Location | |||||||||
| Address1: | 1704 E ARLINGTON BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278587828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2527564899 | ||||||||
| FaxNumber: | 2527565141 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2014 | ||||||||
| LastUpdateDate: | 01/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 5006737 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LF0000X | 5006737 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.