Provider Demographics
NPI:1790293637
Name:RUCK, HEATHER (C-AA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:RUCK
Suffix:
Gender:F
Credentials:C-AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 W 4TH ST APT 208
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64105-4505
Mailing Address - Country:US
Mailing Address - Phone:636-675-4367
Mailing Address - Fax:
Practice Address - Street 1:2401 GILLHAM ROAD
Practice Address - Street 2:CHILDREN'S MERCY HOSPITAL-DEPT OF ANESTHESIA
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108
Practice Address - Country:US
Practice Address - Phone:636-675-4367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017041019367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant