Basic Information
| Provider Information | |||||||||
| NPI: | 1902903586 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ANDERSON | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 875743 | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641875743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132155008 | ||||||||
| FaxNumber: | 8164473960 | ||||||||
| Practice Location | |||||||||
| Address1: | 10977 GRANADA LN | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | LEAWOOD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9132155008 | ||||||||
| FaxNumber: | 8164473960 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2006 | ||||||||
| LastUpdateDate: | 12/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 04-30906 | KS | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
ID Information
| ID | Type | State | Issuer | Description | P00251353 | 01 | RAILROAD MEDICARE | OTHER | 35761019 | 01 | MO | BCBS KANSAS CITY | OTHER | 200331610A | 05 | KS | MEDICAID | 207369000 | 05 | MO | MEDICAID |