Provider Demographics
NPI:1982480638
Name:HEFFREN, KAITLYN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:HEFFREN
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 1:1603 TULLAMORE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61704-9623
Mailing Address - Country:US
Mailing Address - Phone:309-808-6407
Mailing Address - Fax:
Practice Address - Street 1:1603 TULLAMORE AVE STE A
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-9623
Practice Address - Country:US
Practice Address - Phone:309-808-6407
Practice Address - Fax:309-807-5478
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.027996363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily