Provider Demographics
NPI:1932429727
Name:HEISINGER, JONATHAN ANDREW
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ANDREW
Last Name:HEISINGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3834 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-5341
Mailing Address - Country:US
Mailing Address - Phone:573-462-6966
Mailing Address - Fax:573-635-0815
Practice Address - Street 1:1505 SOUTHWEST BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:MO
Practice Address - Zip Code:65102-1128
Practice Address - Country:US
Practice Address - Phone:573-462-6966
Practice Address - Fax:573-635-0815
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator