Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 04-29643 | KS |
NPI | 1093795619 |
---|---|
Provider Name | Mr. Kent Heady |
First Address | Wichita, KS 67205 |
Second Address | Wichita, KS 67205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2006 |
Last Update Date | 19/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100424160A | (05) | KS |
H62206 | (02) | KS |