Provider Demographics
NPI:1477367993
Name:MORIN, HEATHER MARIE (AGNP-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:MORIN
Suffix:
Gender:
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W NELSON ST
Mailing Address - Street 2:
Mailing Address - City:EDGERTON
Mailing Address - State:KS
Mailing Address - Zip Code:66021-2317
Mailing Address - Country:US
Mailing Address - Phone:913-515-2621
Mailing Address - Fax:
Practice Address - Street 1:3343 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4917
Practice Address - Country:US
Practice Address - Phone:316-260-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-83775-112363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS53-83775-112OtherAGNP-C LICENSE NUMBER
KS13-125984-112OtherREGISTERED NURSE LICENSE NUMBER