Provider Demographics
NPI:1427302769
Name:HECK, CRYSTAL LYNETTE (ARNP)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:LYNETTE
Last Name:HECK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-2649
Mailing Address - Country:US
Mailing Address - Phone:904-614-7755
Mailing Address - Fax:
Practice Address - Street 1:2907 KEYSTONE DR
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-1724
Practice Address - Country:US
Practice Address - Phone:573-803-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2019-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9278777363LF0000X
MS901943363LF0000X
MO2019023267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily