Basic Information
| Provider Information | |||||||||
| NPI: | 1235388703 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAY | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | CFNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 606 WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | RAVENSWOOD | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261641730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3042731033 | ||||||||
| FaxNumber: | 3042731034 | ||||||||
| Practice Location | |||||||||
| Address1: | 512A CHURCH ST S | ||||||||
| Address2: | |||||||||
| City: | RIPLEY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 252711616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043721033 | ||||||||
| FaxNumber: | 3043730223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2008 | ||||||||
| LastUpdateDate: | 04/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WM0705X | 63927 | WV | N | Nursing Service Providers | Registered Nurse | Medical-Surgical | 363LF0000X | APRN63927NP | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 31-0942184 | 01 | WV | TAX ID | OTHER |