Provider Demographics
NPI:1194910174
Name:HEIDENREICH, RACHEL SUE (APRN)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:SUE
Last Name:HEIDENREICH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 BURLINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1513
Mailing Address - Country:US
Mailing Address - Phone:859-363-2060
Mailing Address - Fax:859-647-3594
Practice Address - Street 1:7505 BURLINGTON PIKE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1513
Practice Address - Country:US
Practice Address - Phone:859-363-2060
Practice Address - Fax:859-647-3594
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005308363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY11980796OtherCAQH
KY7100044870Medicaid