Healthcare Provider Details

I. General information

NPI: 1710515366
Provider Name (Legal Business Name): KAYELINDA MARIE HEINER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2020
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S ADAMS ST
NEVADA MO
64772-3210
US

IV. Provider business mailing address

301 4TH ST STE 3H
ALEXANDRIA LA
71301-8411
US

V. Phone/Fax

Practice location:
  • Phone: 417-667-6015
  • Fax: 417-667-4234
Mailing address:
  • Phone: 318-441-1041
  • Fax: 318-441-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2025013998
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025013998
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: