Healthcare Provider Details

I. General information

NPI: 1215495437
Provider Name (Legal Business Name): KELLY DAWN HEUER RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 W 9TH ST
HOISINGTON KS
67544-1799
US

IV. Provider business mailing address

250 W 9TH ST
HOISINGTON KS
67544-1799
US

V. Phone/Fax

Practice location:
  • Phone: 620-653-2114
  • Fax: 620-653-2350
Mailing address:
  • Phone: 620-653-2114
  • Fax: 620-653-2350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number13-127834
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: