1467961466 NPI number — HEATHER LEANN HAYDEN APRN

Table of content: HEATHER LEANN HAYDEN APRN (NPI 1467961466)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467961466 NPI number — HEATHER LEANN HAYDEN APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAYDEN
Provider First Name:
HEATHER
Provider Middle Name:
LEANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOONEYHAM
Provider Other First Name:
HEATHER
Provider Other Middle Name:
LEANN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1467961466
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
302 N HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIRARD
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66743-2000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-724-8297
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 N HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIRARD
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66743-2000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-231-9873
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  2017034293 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 79430 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)