Provider Demographics
NPI:1598199770
Name:IRVING, HEATHER L (APRN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:IRVING
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 E 6TH AVE STE 2C
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-3145
Mailing Address - Country:US
Mailing Address - Phone:620-402-6699
Mailing Address - Fax:620-402-6061
Practice Address - Street 1:1230 E 6TH AVE STE 2C
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-3145
Practice Address - Country:US
Practice Address - Phone:620-402-6699
Practice Address - Fax:620-402-6061
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5376120363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201082180BMedicaid