Provider Demographics
NPI:1336327048
Name:HEFFNER, KRISTY JO (MA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:JO
Last Name:HEFFNER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 SAN MATEO BLVD NE
Mailing Address - Street 2:S-14
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4058
Mailing Address - Country:US
Mailing Address - Phone:505-830-1871
Mailing Address - Fax:
Practice Address - Street 1:2403 SAN MATEO BLVD NE
Practice Address - Street 2:S-14
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4058
Practice Address - Country:US
Practice Address - Phone:505-830-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health