Provider Demographics
NPI:1013763382
Name:HEARTLAND WOUND AND URGENT CARE
Entity Type:Organization
Organization Name:HEARTLAND WOUND AND URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNE/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PROVENCE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-C
Authorized Official - Phone:913-207-5089
Mailing Address - Street 1:15845 GARDNER WEST RD
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-9507
Mailing Address - Country:US
Mailing Address - Phone:913-207-5089
Mailing Address - Fax:
Practice Address - Street 1:15845 GARDNER WEST RD
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-9507
Practice Address - Country:US
Practice Address - Phone:913-207-5089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty