Provider Demographics
NPI:1861852469
Name:HEINS-ERICKSON, KATHRYN ANN (APRN)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANN
Last Name:HEINS-ERICKSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1024 LANE STREET
Mailing Address - Street 2:
Mailing Address - City:CLAY CENTER
Mailing Address - State:KS
Mailing Address - Zip Code:67432-2211
Mailing Address - Country:US
Mailing Address - Phone:785-632-6415
Mailing Address - Fax:
Practice Address - Street 1:409 LINCOLN AVE
Practice Address - Street 2:ERICKSON MEDICAL CLINIC LLC
Practice Address - City:CLAY CENTER
Practice Address - State:KS
Practice Address - Zip Code:67432-2907
Practice Address - Country:US
Practice Address - Phone:785-777-2622
Practice Address - Fax:785-777-2623
Is Sole Proprietor?:No
Enumeration Date:2016-02-25
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77025-122363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111192001Medicare PIN