Individual
SUSAN DIANE OTT HEASLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
103 N MAIN ST, CHENEY, KS 67025-8844
(620) 259-6221
(316) 540-6193
Mailing address
2101 N WALDRON ST, HUTCHINSON, KS 67502-1197
(620) 669-2500
(316) 540-6193
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
05-45046
KS
207Q00000X
Family Medicine Physician
2011020340
MO
207R00000X
Internal Medicine Physician
6554
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1336360254
—
MO
01
—
431560263
TRICARE
MO
01
—
P00985977
RR MCR
MO
Enumeration date
05/01/2007
Last updated
02/02/2022
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