Provider Demographics
NPI:1942015615
Name:HEISEY, KRISTINE ANN
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ANN
Last Name:HEISEY
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 1:1015 SOLANA CREST ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5086
Mailing Address - Country:US
Mailing Address - Phone:702-994-8814
Mailing Address - Fax:
Practice Address - Street 1:8781 W ARDENE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-2699
Practice Address - Country:US
Practice Address - Phone:208-229-8441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2271945225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist