Provider Demographics
NPI:1669081519
Name:HEYTENS, SAN JUANITA (APRN)
Entity type:Individual
Prefix:
First Name:SAN JUANITA
Middle Name:
Last Name:HEYTENS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SAN JUANITA
Other - Middle Name:
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, APRN, FNP-C
Mailing Address - Street 1:1513 W WYATT EARP BLVD
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-3352
Mailing Address - Country:US
Mailing Address - Phone:620-682-8304
Mailing Address - Fax:
Practice Address - Street 1:1513 W WYATT EARP BLVD
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-3352
Practice Address - Country:US
Practice Address - Phone:620-682-8304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2024-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS101659163W00000X
KS53-81235-122363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse