Provider Demographics
NPI:1518999770
Name:HESTON, WILLIAM KENNETH (CRNA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:KENNETH
Last Name:HESTON
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-1530
Mailing Address - Country:US
Mailing Address - Phone:605-642-3113
Mailing Address - Fax:605-642-3117
Practice Address - Street 1:1316 N 10TH ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-1530
Practice Address - Country:US
Practice Address - Phone:605-642-3113
Practice Address - Fax:605-642-3117
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCR000179367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
430058457OtherRR MEDICARE
MT438620OtherMEDICAID
WY110048300OtherMEDICAID
SD9212491OtherDAKOTA CARE
SD0006915OtherBCBS
SD5750107Medicaid
SD0006915OtherBCBS