Basic Information
| Provider Information | |||||||||
| NPI: | 1659480762 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEIMSOTH | ||||||||
| FirstName: | CYNNTHIA | ||||||||
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| Credential: | GNP, CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 KATY CIR | ||||||||
| Address2: | |||||||||
| City: | SEDALIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 653016782 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1300 VETERANS RD | ||||||||
| Address2: | |||||||||
| City: | WARRENSBURG | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640938294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8168614700 | ||||||||
| FaxNumber: | 6607478197 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 102835 | IA | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 364SA2200X | 068159 | MO | X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Adult Health |
No ID Information.