Provider Demographics
NPI:1902903586
Name:ANDERSON, HEATHER S (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:S
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 875743
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64187-5743
Mailing Address - Country:US
Mailing Address - Phone:913-215-5008
Mailing Address - Fax:816-447-3960
Practice Address - Street 1:10977 GRANADA LN
Practice Address - Street 2:SUITE 105
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1468
Practice Address - Country:US
Practice Address - Phone:913-215-5008
Practice Address - Fax:816-447-3960
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-309062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00251353OtherRAILROAD MEDICARE
MO35761019OtherBCBS KANSAS CITY
KS200331610AMedicaid
MO207369000Medicaid
P00251353OtherRAILROAD MEDICARE
MO35761019OtherBCBS KANSAS CITY