Provider Demographics
NPI:1588481543
Name:KISKADDEN, HEATHER RENA (FNP-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENA
Last Name:KISKADDEN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 S MICHELE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT ORAB
Mailing Address - State:OH
Mailing Address - Zip Code:45154-8303
Mailing Address - Country:US
Mailing Address - Phone:304-382-3387
Mailing Address - Fax:
Practice Address - Street 1:230 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:SEAMAN
Practice Address - State:OH
Practice Address - Zip Code:45679-8002
Practice Address - Country:US
Practice Address - Phone:304-382-3387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0037585363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily