Provider Demographics
NPI:1689135824
Name:HEIDBRINK, KAYLA RENEE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RENEE
Last Name:HEIDBRINK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 HIGHWAY 50 E
Mailing Address - Street 2:
Mailing Address - City:LINN
Mailing Address - State:MO
Mailing Address - Zip Code:65051-3212
Mailing Address - Country:US
Mailing Address - Phone:573-644-2500
Mailing Address - Fax:
Practice Address - Street 1:1 CHILDREN'S WAY, SLOT ACH 512-19A
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202
Practice Address - Country:US
Practice Address - Phone:502-364-1874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program