Provider Demographics
NPI:1124468152
Name:HEARD, KRISTEN LYNN (DPM)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:LYNN
Last Name:HEARD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LECOM PL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:814-868-2522
Practice Address - Street 1:2010 W 38TH ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2004
Practice Address - Country:US
Practice Address - Phone:814-868-5481
Practice Address - Fax:814-868-7608
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006515213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031267420005Medicaid
PA1031267420007Medicaid
PA1031267420006Medicaid
PA1031267420001Medicaid
PA502209US8Medicare PIN