Provider Demographics
NPI:1699002253
Name:BRILLHART, HEIDY REBEKAH (APRN)
Entity Type:Individual
Prefix:MRS
First Name:HEIDY
Middle Name:REBEKAH
Last Name:BRILLHART
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:P.O. BOX 460
Mailing Address - Street 2:411 SUNSET
Mailing Address - City:ELKHART
Mailing Address - State:KS
Mailing Address - Zip Code:67950-0460
Mailing Address - Country:US
Mailing Address - Phone:620-697-2175
Mailing Address - Fax:620-697-2185
Practice Address - Street 1:411 SUNSET
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:KS
Practice Address - Zip Code:67950-0460
Practice Address - Country:US
Practice Address - Phone:620-697-2175
Practice Address - Fax:620-697-2185
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0072633363LF0000X
KS53-76427-042363LF0000X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201108100AMedicaid