Provider Demographics
NPI:1457890949
Name:BRIDGENS, HEATHER DOEREN (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DOEREN
Last Name:BRIDGENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 GRAND BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-1803
Mailing Address - Country:US
Mailing Address - Phone:913-297-7472
Mailing Address - Fax:816-527-0171
Practice Address - Street 1:1916 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-1803
Practice Address - Country:US
Practice Address - Phone:913-297-7472
Practice Address - Fax:855-461-1769
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-02001363A00000X
MO2017026356363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant