Provider Demographics
NPI:1629551718
Name:HECKER, JAMES KENNETH
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KENNETH
Last Name:HECKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 SW GREENWICH DR # 224
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4408
Mailing Address - Country:US
Mailing Address - Phone:816-820-9489
Mailing Address - Fax:
Practice Address - Street 1:4629 S EASTLAND CENTER DR # AT1528
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7830
Practice Address - Country:US
Practice Address - Phone:816-820-9489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOB112063011172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver