Healthcare Provider Details

I. General information

NPI: 1629994397
Provider Name (Legal Business Name): MELISSA HEIDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA SHEAR

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

639 YORK ST
QUINCY IL
62301-3963
US

IV. Provider business mailing address

902 W MAIN ST
WEST FRANKFORT IL
62896-2210
US

V. Phone/Fax

Practice location:
  • Phone: 217-222-6277
  • Fax: 618-224-1155
Mailing address:
  • Phone: 618-326-2772
  • Fax: 618-937-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number041.402180
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: