Provider Demographics
NPI:1225208325
Name:HEATHCOTTE, KIMBERLY E (NP)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:E
Last Name:HEATHCOTTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3868
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47737-3868
Mailing Address - Country:US
Mailing Address - Phone:812-426-9355
Mailing Address - Fax:812-858-4539
Practice Address - Street 1:421 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47713-1227
Practice Address - Country:US
Practice Address - Phone:812-426-9355
Practice Address - Fax:812-858-4539
Is Sole Proprietor?:No
Enumeration Date:2008-03-04
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002552A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400034103Medicare PIN