Provider Demographics
NPI:1053618991
Name:HEDDEN, DANIELLE K (FNP-C)
Entity type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:K
Last Name:HEDDEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5610
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31010-5610
Mailing Address - Country:US
Mailing Address - Phone:229-273-8881
Mailing Address - Fax:229-273-8985
Practice Address - Street 1:804 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015-1514
Practice Address - Country:US
Practice Address - Phone:229-273-8881
Practice Address - Fax:229-273-8985
Is Sole Proprietor?:No
Enumeration Date:2011-02-11
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN129700363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003106943EMedicaid