Healthcare Provider Details

I. General information

NPI: 1144966474
Provider Name (Legal Business Name): HEIDI MCKINDRA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16579 WINSOME WAY
COLORADO SPRINGS CO
80908-1154
US

IV. Provider business mailing address

2 S CASCADE AVE STE 140
COLORADO SPRINGS CO
80903-1604
US

V. Phone/Fax

Practice location:
  • Phone: 805-598-4215
  • Fax:
Mailing address:
  • Phone: 719-463-5574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1627500
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: