Healthcare Provider Details

I. General information

NPI: 1285937938
Provider Name (Legal Business Name): HEATHER J. BASTIAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2010
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S PINE ST
NEWTON KS
67114-3765
US

IV. Provider business mailing address

215 S PINE ST
NEWTON KS
67114-3765
US

V. Phone/Fax

Practice location:
  • Phone: 316-283-6103
  • Fax: 316-283-1333
Mailing address:
  • Phone: 316-283-6103
  • Fax: 316-283-1333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR35762
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-75243
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: