Healthcare Provider Details

I. General information

NPI: 1477514164
Provider Name (Legal Business Name): JENNIFER L HEINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 12/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 SHAWNEE MISSION PKWY
WESTWOOD KS
66205-2005
US

IV. Provider business mailing address

2330 SHAWNEE MISSION PKWY SUITE 210
WESTWOOD KS
66205-2005
US

V. Phone/Fax

Practice location:
  • Phone: 913-588-6029
  • Fax: 913-588-4085
Mailing address:
  • Phone: 913-588-6029
  • Fax: 913-588-4085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-01211
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: