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General NPI Number Information
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NPI Number | 1013763382
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Entity Type | Organization
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Legal Business Name | HEARTLAND WOUND AND URGENT CARE
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Dates
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Enumeration Date | 04/27/2024
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 15845 GARDNER WEST RD
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City | GARDNER
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State | KS
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Zip | 66030-9507
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Country | US
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Telephone | 913-207-5089
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Fax | 913-273-1094
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Provider Business Mailing Address
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Address Line | 15845 GARDNER WEST RD
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City | GARDNER
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State | KS
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Zip | 66030-9507
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Country | US
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Telephone | 913-207-5089
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Fax |
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Authorized Official
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Title or Position | OWNE/NURSE PRACTITIONER
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Name | KRISTY M PROVENCE
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Credential | APRN-C
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Telephone | 913-207-5089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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