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General NPI Number Information
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NPI Number | 1053973081
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Entity Type | Individual
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Provider Name | HEATHER ELIZABETH POLK APRN
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Gender | Female
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Dates
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Enumeration Date | 06/29/2019
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Last Update Date | 04/14/2020
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Provider Practice Location Address
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Address Line | 200 SOUTHLAND DR
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City | SIKESTON
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State | MO
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Zip | 63801-4403
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Country | US
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Telephone | 573-472-1770
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Fax | 573-472-4050
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Provider Business Mailing Address
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Address Line | 6738 STATE HIGHWAY 77
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City | BENTON
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State | MO
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Zip | 63736-8238
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Country | US
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Telephone | 573-313-2500
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Fax | 573-313-2500
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 2019022989
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License Number State | MO
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