Healthcare Provider Details

I. General information

NPI: 1003706979
Provider Name (Legal Business Name): HEARTLAND NURSING GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N HERITAGE DR STE 103
RIDGECREST CA
93555-5541
US

IV. Provider business mailing address

435 TEPATITLAN CT
RIDGECREST CA
93555-3164
US

V. Phone/Fax

Practice location:
  • Phone: 442-270-5333
  • Fax:
Mailing address:
  • Phone: 442-270-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number
License Number State

VIII. Authorized Official

Name: MA JINKY MALLORY
Title or Position: OWNER
Credential: RN
Phone: 442-270-5333