Provider Demographics
NPI:1710976832
Name:HEINEN, KATHRYN A (ARNP C MSN)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:A
Last Name:HEINEN
Suffix:
Gender:F
Credentials:ARNP C MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:WETMORE
Mailing Address - State:KS
Mailing Address - Zip Code:66550-0249
Mailing Address - Country:US
Mailing Address - Phone:785-866-4775
Mailing Address - Fax:785-866-4204
Practice Address - Street 1:323 SECOND ST
Practice Address - Street 2:
Practice Address - City:WETMORE
Practice Address - State:KS
Practice Address - Zip Code:66550-0249
Practice Address - Country:US
Practice Address - Phone:785-866-4775
Practice Address - Fax:785-866-4204
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS161296OtherBLUE CROSS BLUE SHIELD
173859Medicare ID - Type Unspecified