| Doctor Name: | MRS. HEATHER ANN BAGLEY |
| NPI Number: | 1720312523 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 20366A |
| Business Practice Address: | 120 East Howard Avenue Teton Valley Hospital & Surgicenter Driggs, ID - 834225112 |
| Business Phone Number: | 2083542302 |
| Business Fax Number: | |
| Mailing Address: | 9790 S 2000 W, VICTOR |
| State: | ID |
| Postal Code: | 834555238 |
| Phone Number: | 2087057514 |
| Fax Number: | |
| NPI Enumeration Date: | 09/25/2009 |
| NPI Last Update Date: | 09/25/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | 20366A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |