Mrs. Heather Elizabeth Polk
Nurse Practitioner - Primary Care
200 Southland Dr
Sikeston
, Missouri 63801-4403
Mrs. Heather Elizabeth Polk
Nurse Practitioner - Primary Care
200 Southland Dr
Sikeston
, Missouri 63801-4403
(573) 313-2500
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About
Features
Specialties
- Nurse Practitioner - Primary Care
Languages spoken
- English
Location
First Address
- Mrs. Heather Elizabeth Polk
- 6738 State Highway 77
- Benton, MO
- Zip : 63736-8238
- Fax : (573) 313-2500
- Phone : (573) 313-2500
Second Address
- Mrs. Heather Elizabeth Polk
- 200 Southland Dr
- Sikeston, MO
- Zip : 63801-4403
- Fax : (573) 472-4050
- Phone : (573) 472-1770
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LP2300X | Nurse Practitioner - Primary Care | 2019022989 | MO |
National Provider Identifier
| NPI | 1053973081 |
|---|---|
| Provider Name | Mrs. Heather Elizabeth Polk |
| First Address | Benton, MO 63736-8238 |
| Second Address | Sikeston, MO 63801-4403 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 29/06/2019 |
| Last Update Date | 14/04/2020 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 2019022989 | MISSOURI STATE BOARD OF NURSING (01) | MO |
| 420077159 | (05) | MO |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.