1699905943 NPI number — DR. HEATHER JEANNE MCWILLIAMS DO

Table of content: DR. HEATHER JEANNE MCWILLIAMS DO (NPI 1699905943)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699905943 NPI number — DR. HEATHER JEANNE MCWILLIAMS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCWILLIAMS
Provider First Name:
HEATHER
Provider Middle Name:
JEANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RIDDER
Provider Other First Name:
HEATHER
Provider Other Middle Name:
JEANNE
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:
1699905943
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9411 N OAK TRFY STE LL1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64155-2262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-691-1655
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 CLAY EDWARDS DR
Provider Second Line Business Practice Location Address:
SUITE 240
Provider Business Practice Location Address City Name:
NORTH KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64116-3251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-455-0681
Provider Business Practice Location Address Fax Number:
816-455-5294
Provider Enumeration Date:
07/21/2009

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: 207R00000X , with the licence number:  2012012184 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 2012012184 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1699905943 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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