Healthcare Provider Details

I. General information

NPI: 1376308486
Provider Name (Legal Business Name): HEIDI MARIE PROCKISH MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 SW 6TH AVE
TOPEKA KS
66606-2814
US

IV. Provider business mailing address

5120 SW 28TH ST
TOPEKA KS
66614-2321
US

V. Phone/Fax

Practice location:
  • Phone: 785-235-0335
  • Fax:
Mailing address:
  • Phone: 785-408-5800
  • Fax: 785-730-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-82904-091
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-82904-091
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number82904
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number53-82904-091
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: