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General NPI Number Information
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NPI Number | 1023808458
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Entity Type | Individual
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Provider Name | HALEY LEANN HEATON
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Gender | Female
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Dates
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Enumeration Date | 05/08/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 627 S TRUMAN BLVD
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City | FESTUS
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State | MO
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Zip | 63028-2234
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Country | US
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Telephone | 636-937-7920
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Fax |
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Provider Business Mailing Address
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Address Line | 10324 HILLCREST RD APT 27
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City | KANSAS CITY
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State | MO
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Zip | 64134-4334
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 2025019804
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License Number State | MO
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