Individual
DERRICK PAUL HEATHERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
4251 NORTHERN AVE, KANSAS CITY, MO 64133-1593
(816) 861-4700
Mailing address
601 NE 2ND ST, BLUE SPRINGS, MO 64014-2903
(816) 933-3663
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
2001027589
MO
Other
Enumeration date
02/25/2025
Last updated
02/25/2025
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