Provider Demographics
NPI:1437794773
Name:HEIFNER, KIMBERLY NICOLE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:NICOLE
Last Name:HEIFNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:NICOLE
Other - Last Name:OTTENSMEYER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16111 MANCHESTER ROAD
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63011
Mailing Address - Country:US
Mailing Address - Phone:636-751-9440
Mailing Address - Fax:515-631-5129
Practice Address - Street 1:16111 MANCHESTER ROAD
Practice Address - Street 2:
Practice Address - City:ELLISVILLE
Practice Address - State:MO
Practice Address - Zip Code:63011
Practice Address - Country:US
Practice Address - Phone:636-751-9440
Practice Address - Fax:515-631-5129
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019042207363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily