Provider Demographics
NPI:1477503100
Name:KISTNER, HEATHER L (MS, CCC-A)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:KISTNER
Suffix:
Gender:F
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 N EASTMAN RD
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-3156
Mailing Address - Country:US
Mailing Address - Phone:423-247-5771
Mailing Address - Fax:423-247-5775
Practice Address - Street 1:1103 N EASTMAN RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-3156
Practice Address - Country:US
Practice Address - Phone:423-247-5771
Practice Address - Fax:423-247-5775
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1381231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0100OtherJOHN DEERE HEALTH
4073516OtherBLUE CROSS BLUE SHIELD
135756OtherPREFERRED CARE
TN0100OtherJOHN DEERE HEALTH