Provider Demographics
NPI:1700420916
Name:RHODES, HEATHER A (MSN, FPMHNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:RHODES
Suffix:
Gender:F
Credentials:MSN, FPMHNP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:BUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17844 E 23RD ST S
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-1840
Mailing Address - Country:US
Mailing Address - Phone:816-254-3652
Mailing Address - Fax:816-257-2575
Practice Address - Street 1:17611 E US HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64056-1853
Practice Address - Country:US
Practice Address - Phone:816-254-3652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020032337363LP0808X
KS13-70739-052163W00000X
KS53-79222-052363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse