Provider Demographics
NPI:1093240111
Name:CHOUTEAU, HEATHER WHITAKER (DO)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:WHITAKER
Last Name:CHOUTEAU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ASHLEY
Other - Last Name:WHITAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:355 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2207
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:334 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-3464
Practice Address - Country:US
Practice Address - Phone:859-301-5901
Practice Address - Fax:859-301-5940
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005748A2084P0800X, 390200000X
KY053362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300003447Medicaid