Individual
KENNY JOSEPH HEFFERNAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2411 FOUNTAIN VIEW DR, SUITE 200, HOUSTON, TX 77057-4817
(713) 458-4185
Mailing address
2411 FOUNTAIN VIEW DR, SUITE 200, HOUSTON, TX 77057-4817
(713) 458-4185
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
724948
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
185864901
—
TX
01
—
87035U
BLUE CROSS
TX
01
—
P00396676
RAILROAD MEDICARE
TX
01
—
P00643957
MEDICARE RAILROAD
TX
Enumeration date
01/30/2007
Last updated
08/27/2009
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