Provider Demographics
NPI:1497395529
Name:HEIDEGER, KRISTEN DANIELLE
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:DANIELLE
Last Name:HEIDEGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SUSSEX DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35824-1306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2006 FRANKLIN ST SE STE 102
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4537
Practice Address - Country:US
Practice Address - Phone:256-251-5121
Practice Address - Fax:256-469-6061
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1148214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily