MEDICARE: HEATHER KEARBY 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	363LP2300X	Primary Care Nurse Practitioner	71014926A	IN
2	363LF0000X	Family Nurse Practitioner	71014926A	IN

General Provider Information

NPI Number	:	1588424477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER KEARBY FNP

Provider Business Mailing Address
First Line	:	4454 S OLD STATE ROAD 145
Second Line	:
City	:	FRENCH LICK
State	:	IN
Zip	:	47432-9431
Country	:	US
Telephone Number	:	812-296-7067
Fax Number	:

Provider Business Practice Location Address
First Line	:	8163 W STATE ROAD 56
Second Line	:
City	:	WEST BADEN SPRINGS
State	:	IN
Zip	:	47469-7706
Country	:	US
Telephone Number	:	812-723-7125
Fax Number	:

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

Provider Enumeration Date	:	03/19/2024
Last Update Date	:	11/26/2024

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