Provider Demographics
NPI:1821651167
Name:CARROLL, HEIDI MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:MARIE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 N RIVERVIEW ST STE 500
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4265
Mailing Address - Country:US
Mailing Address - Phone:316-616-1055
Mailing Address - Fax:
Practice Address - Street 1:345 N RIVERVIEW ST STE 500
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4265
Practice Address - Country:US
Practice Address - Phone:316-616-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019019672363LF0000X, 363LF0000X
KS53-78794-091363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily