MEDICARE: TERISA M. HEEVNER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2019019679	MO

General Provider Information

NPI Number	:	1114581287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERISA M. HEEVNER FNP

Provider Business Mailing Address
First Line	:	4715 W US 40 HWY
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-0951
Country	:	US
Telephone Number	:	816-229-9118
Fax Number	:	816-463-7107

Provider Business Practice Location Address
First Line	:	4715 W US 40 HWY
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64015-0951
Country	:	US
Telephone Number	:	816-229-9118
Fax Number	:	816-463-7107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2019
Last Update Date	:	04/16/2026

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