Individual
MR. WILLIE STEPHAN VAN HEERDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N. STATE STREET, JACKSON, MS 39216
(601) 674-1000
Mailing address
1865 LAKELAND DR APT 108, JACKSON, MS 39216-4960
(681) 267-9708
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
T-5800
MS
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
05/21/2025
Last updated
02/17/2026
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