Provider Demographics
NPI:1457438376
Name:PECK, HEIDI LOUISE (PA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:LOUISE
Last Name:PECK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 26604
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64196-6604
Mailing Address - Country:US
Mailing Address - Phone:913-677-3113
Mailing Address - Fax:913-677-4514
Practice Address - Street 1:9119 W 74TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2236
Practice Address - Country:US
Practice Address - Phone:913-677-3113
Practice Address - Fax:913-677-4514
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00569363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical