Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | A143918 | IA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | CP000555 | SD |
NPI | 1003046939 |
---|---|
Provider Name | Kathi Kae Heckert |
First Address | Spencer, IA 51301-4300 |
Second Address | Spencer, IA 51301-4300 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2009 |
Last Update Date | 11/05/2017 |