Basic Information
| Provider Information | |||||||||
| NPI: | 1982233136 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEELY | ||||||||
| FirstName: | NICOLE | ||||||||
| MiddleName: | ASHLEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | CPNP-AC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6511 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232263031 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102433220 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5875 BREMO RD STE 306 | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232261934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042818303 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2020 | ||||||||
| LastUpdateDate: | 06/30/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 0024179147 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.