Provider Demographics
NPI:1639607781
Name:POLLET, HEATHER LEE (APRN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEE
Last Name:POLLET
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:RR 1 BOX 207-50
Mailing Address - Street 2:
Mailing Address - City:S COFFEYVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74072-9754
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1400 W 4TH ST
Practice Address - Street 2:
Practice Address - City:COFFEYVILLE
Practice Address - State:KS
Practice Address - Zip Code:67337-3306
Practice Address - Country:US
Practice Address - Phone:620-252-1639
Practice Address - Fax:620-252-1541
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-88134-091163WS0200X
KS53-77703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WS0200XNursing Service ProvidersRegistered NurseSchool