Provider Demographics
NPI:1801852116
Name:HEYDINGER, EDY G (CPNP)
Entity Type:Individual
Prefix:MR
First Name:EDY
Middle Name:G
Last Name:HEYDINGER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2401 GILLHAM RD
Mailing Address - Street 2:GENERAL PEDIATRICS- 5 WEST
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-4619
Mailing Address - Country:US
Mailing Address - Phone:816-234-3898
Mailing Address - Fax:816-855-1940
Practice Address - Street 1:2401 GILLHAM RD
Practice Address - Street 2:GENERAL PEDIATRICS- 5 WEST
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-4619
Practice Address - Country:US
Practice Address - Phone:816-234-3898
Practice Address - Fax:816-855-1940
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO146240363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO423811405Medicaid
MO269B633Medicare ID - Type Unspecified
P52015Medicare UPIN