Provider Demographics
NPI:1770705253
Name:ROE, HEATHER LEANNE (DO)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:LEANNE
Last Name:ROE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6135 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4209
Mailing Address - Country:US
Mailing Address - Phone:316-854-1045
Mailing Address - Fax:316-854-5262
Practice Address - Street 1:6135 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4209
Practice Address - Country:US
Practice Address - Phone:316-854-1045
Practice Address - Fax:316-854-5262
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0533067207P00000X, 207Q00000X
KS05-33067207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine