Provider Demographics
NPI:1003046939
Name:HECKERT, KATHI KAE (CNP)
Entity Type:Individual
Prefix:
First Name:KATHI
Middle Name:KAE
Last Name:HECKERT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E 11TH ST
Mailing Address - Street 2:STE 101
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-4300
Mailing Address - Country:US
Mailing Address - Phone:712-264-3500
Mailing Address - Fax:712-264-3535
Practice Address - Street 1:116 E 11TH ST
Practice Address - Street 2:STE 101
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-4300
Practice Address - Country:US
Practice Address - Phone:712-264-3500
Practice Address - Fax:712-264-3535
Is Sole Proprietor?:No
Enumeration Date:2009-07-27
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000555363LF0000X
IAA143918363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6832416Medicaid
SDS105007Medicare PIN