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NPI Code Detail

MEDICARE: DR. NICHOLAS B HEINECKE PSY.D.

MEDICARE: DR. NICHOLAS B HEINECKE PSY.D.
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
1103T00000XPsychologist2009034689MO

General Provider Information

NPI Number : 1295052496
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NICHOLAS B HEINECKE PSY.D.
Provider Business Mailing Address
First Line : 4251 NORTHERN AVE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64133-1593
Country : US
Telephone Number : 816-861-4700
Fax Number :
Provider Business Practice Location Address
First Line : 4251 NORTHERN AVE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64133-1593
Country : US
Telephone Number : 816-861-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2010
Last Update Date : 12/02/2022

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