Heather Nicole Mangrum, FNP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

15204 Issued in TN

Practice address

125 Crestview Park Dr Ste 2
Dickson, TN 37055-2853

Phone

(615) 740-5233

Fax

(615) 740-5226

NPI assigned

Sep 26, 2010

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Heather Mangrum Former name

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: heather.mangrum@entsa.directbygreenway.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523232000000",
    "number": "1013226026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 CRESTVIEW PARK DR STE 2",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370552853",
            "telephone_number": "615-740-5233",
            "fax_number": "615-740-5226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 CRESTVIEW PARK DR STE 2",
            "city": "DICKSON",
            "state": "TN",
            "postal_code": "370552853",
            "telephone_number": "615-740-5233",
            "fax_number": "615-740-5226"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3443 Dickerson Pike Ste 320",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372072523",
            "country_code": "US",
            "telephone_number": "615-988-9787",
            "fax_number": "615-988-9797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MANGRUM",
        "first_name": "HEATHER",
        "middle_name": "NICOLE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-26",
        "last_updated": "2018-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TN",
            "license": "15204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1530456",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "MANGRUM",
            "credential": "FNP-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Vinh Le Mai, PHARMD
• Main Street Interventions
• Treeah Majors, FNP-BC
• Jose Malave, MD
• Andrew Carl Mangrum, M.DIV.
• Kylie Mangrum, APRN
• Venk Mani, MD
• Toni J Marcum, DT, OTR/L
• Austin B Marlow, PA
• Naimisha Marneni, MD

• Nurse Practitioner in Dickson, TN
• Providers in Dickson, TN by specialty
• Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.