Healthcare Provider Details

I. General information

NPI: 1588424477
Provider Name (Legal Business Name): HEATHER KEARBY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2024
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8163 W STATE ROAD 56
WEST BADEN SPRINGS IN
47469-7706
US

IV. Provider business mailing address

4454 S OLD STATE ROAD 145
FRENCH LICK IN
47432-9431
US

V. Phone/Fax

Practice location:
  • Phone: 812-723-7125
  • Fax:
Mailing address:
  • Phone: 812-296-7067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number71014926A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71014926A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: