Healthcare Provider Details

I. General information

NPI: 1952858813
Provider Name (Legal Business Name): HEATHER DUNCAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER KEDDIE

II. Dates (important events)

Enumeration Date: 09/07/2016
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 N HARLEM AVE STE A
CHICAGO IL
60707-3716
US

IV. Provider business mailing address

PO BOX 746715
ATLANTA GA
30374-6715
US

V. Phone/Fax

Practice location:
  • Phone: 773-589-4385
  • Fax: 872-228-8601
Mailing address:
  • Phone: 773-589-4385
  • Fax: 872-228-8601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP 60667634
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60667634
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.024899
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: