Healthcare Provider Details

I. General information

NPI: 1013912559
Provider Name (Legal Business Name): KRISTEN J HEFFERN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 33RD ST S
SAINT CLOUD MN
56301-9668
US

IV. Provider business mailing address

901 MONTGOMERY ST
DECORAH IA
52101-2325
US

V. Phone/Fax

Practice location:
  • Phone: 320-251-8181
  • Fax: 320-257-1733
Mailing address:
  • Phone: 563-382-2911
  • Fax: 563-382-5458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number34
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA086912
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: