Individual
MRS. HEATHER ELIZABETH POLK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
200 SOUTHLAND DR, SIKESTON, MO 63801-4403
(573) 472-1770
(573) 472-4050
Mailing address
6738 STATE HIGHWAY 77, BENTON, MO 63736-8238
(573) 313-2500
(573) 313-2500
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
2019022989
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019022989
MISSOURI STATE BOARD OF NURSING
MO
05
—
420077159
—
MO
Enumeration date
06/29/2019
Last updated
04/14/2020
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