Provider Demographics
NPI:1902122351
Name:KING, HEATHER E (CRNA)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:E
Last Name:KING
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:E
Other - Last Name:DONAWAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:11529 RILEY ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2246
Mailing Address - Country:US
Mailing Address - Phone:913-558-6498
Mailing Address - Fax:
Practice Address - Street 1:10301 HICKMAN MILLS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-1674
Practice Address - Country:US
Practice Address - Phone:816-767-3210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-87415-101163W00000X
MO082622367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse