Healthcare Provider Details

I. General information

NPI: 1134008816
Provider Name (Legal Business Name): KYLIE HEPPNER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 N CANTERBURY CT
BLOOMINGTON IN
47404-1500
US

IV. Provider business mailing address

550 CONGRESSIONAL BLVD STE 115
CARMEL IN
46032-5644
US

V. Phone/Fax

Practice location:
  • Phone: 812-650-3032
  • Fax:
Mailing address:
  • Phone: 317-249-2242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: