Provider Demographics
NPI:1598391484
Name:HEITSCHMIDT, JOURDAN NIKOLE (APN)
Entity Type:Individual
Prefix:
First Name:JOURDAN
Middle Name:NIKOLE
Last Name:HEITSCHMIDT
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:JOURDAN
Other - Middle Name:NIKOLE
Other - Last Name:PREHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1601 OLD SOUTH RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-4120
Mailing Address - Country:US
Mailing Address - Phone:636-224-1210
Mailing Address - Fax:636-246-1008
Practice Address - Street 1:211 MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:KS
Practice Address - Zip Code:66414-9714
Practice Address - Country:US
Practice Address - Phone:785-836-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS79270363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner