Provider Demographics
NPI:1437533858
Name:WILSON, HEATHER MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:GARTIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1700 RAINBOW BLVD
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-1182
Mailing Address - Country:US
Mailing Address - Phone:816-630-6722
Mailing Address - Fax:816-629-3636
Practice Address - Street 1:1700 RAINBOW BLVD
Practice Address - Street 2:
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024-1182
Practice Address - Country:US
Practice Address - Phone:816-630-6722
Practice Address - Fax:816-629-3636
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022031656208D00000X, 207Q00000X, 202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine