Provider Demographics
NPI:1437480738
Name:KREIKEMEIER, HEIDI BESS (RPT)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:BESS
Last Name:KREIKEMEIER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MRS
Other - First Name:HEIDI
Other - Middle Name:BESS
Other - Last Name:WILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:2359 ST DAVIDS SQ
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-6706
Mailing Address - Country:US
Mailing Address - Phone:770-809-4547
Mailing Address - Fax:770-424-9332
Practice Address - Street 1:2359 ST DAVIDS SQ
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-6706
Practice Address - Country:US
Practice Address - Phone:770-809-4547
Practice Address - Fax:770-424-9332
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-26
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004119251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care