Provider Demographics
NPI:1215495437
Name:HEUER, KELLY DAWN (RN, CDE)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:DAWN
Last Name:HEUER
Suffix:
Gender:F
Credentials:RN, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HOISINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67544-1799
Mailing Address - Country:US
Mailing Address - Phone:620-653-2114
Mailing Address - Fax:620-653-2350
Practice Address - Street 1:250 W 9TH ST
Practice Address - Street 2:
Practice Address - City:HOISINGTON
Practice Address - State:KS
Practice Address - Zip Code:67544-1799
Practice Address - Country:US
Practice Address - Phone:620-653-2114
Practice Address - Fax:620-653-2350
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-127834163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator