=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871430421
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEARTLAND WELLNESS MANAGEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2026
-----------------------------------------------------
Last Update Date | 05/01/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 421 W MAIN ST
-----------------------------------------------------
City | CHANUTE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66720-1607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-431-7193
-----------------------------------------------------
Fax | 620-431-7741
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 483
-----------------------------------------------------
City | CHANUTE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66720-0483
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-431-7193
-----------------------------------------------------
Fax | 620-431-7741
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | ELIZABETH NOTHERN
-----------------------------------------------------
Credential | DMSC, PA-C
-----------------------------------------------------
Telephone | 620-431-7193
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------