Provider Demographics
NPI:1013200369
Name:UNGEHEUER, HEATHER J (APRN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:J
Last Name:UNGEHEUER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:J
Other - Last Name:GRACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:823 SW MULVANE LOWER LEVEL
Mailing Address - Street 2:PHYSICIAN SUPPORT SERVICES
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1764
Mailing Address - Country:US
Mailing Address - Phone:785-354-6626
Mailing Address - Fax:785-354-6305
Practice Address - Street 1:901 SW GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1670
Practice Address - Country:US
Practice Address - Phone:785-354-5598
Practice Address - Fax:785-354-5396
Is Sole Proprietor?:No
Enumeration Date:2011-05-19
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75375-101363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200721630BMedicaid
KS068002170OtherMEDICARE PTAN