=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851340558
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER MICHELLE MCCULLOUGH ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2006
-----------------------------------------------------
Last Update Date | 08/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 KELLOGG CIRCLE BOX 4008
-----------------------------------------------------
City | EMPORIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-341-5222
-----------------------------------------------------
Fax | 620-900-1355
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 KELLOGG CIRCLE BOX 4008
-----------------------------------------------------
City | EMPORIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66801
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-341-5222
-----------------------------------------------------
Fax | 620-900-1355
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 45737
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------