Provider Demographics
NPI:1770398604
Name:KOSTEK, HEATHER M (PMHNP)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:KOSTEK
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BLUEBIRD SQ
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2552
Mailing Address - Country:US
Mailing Address - Phone:716-373-1950
Mailing Address - Fax:
Practice Address - Street 1:1 BLUEBIRD SQ
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2552
Practice Address - Country:US
Practice Address - Phone:716-982-7921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406655363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health