Healthcare Provider Details

I. General information

NPI: 1801852116
Provider Name (Legal Business Name): EDY G HEYDINGER CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 GILLHAM RD GENERAL PEDIATRICS- 5 WEST
KANSAS CITY MO
64108-4619
US

IV. Provider business mailing address

2401 GILLHAM RD GENERAL PEDIATRICS- 5 WEST
KANSAS CITY MO
64108-4619
US

V. Phone/Fax

Practice location:
  • Phone: 816-234-3898
  • Fax: 816-855-1940
Mailing address:
  • Phone: 816-234-3898
  • Fax: 816-855-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number146240
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: