Healthcare Provider Details

I. General information

NPI: 1598391484
Provider Name (Legal Business Name): JOURDAN NIKOLE HEITSCHMIDT APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOURDAN NIKOLE PREHN

II. Dates (important events)

Enumeration Date: 03/23/2020
Last Update Date: 01/27/2021
Certification Date: 01/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 MAIN ST
CARBONDALE KS
66414-9714
US

IV. Provider business mailing address

1601 OLD SOUTH RIVER RD
SAINT CHARLES MO
63303-4120
US

V. Phone/Fax

Practice location:
  • Phone: 785-836-7111
  • Fax:
Mailing address:
  • Phone: 636-224-1210
  • Fax: 636-246-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number79270
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: