Individual
HEATHER S BLOOMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5500 E KELLOGG DR, WICHITA, KS 67218-1607
(316) 685-2221
Mailing address
5500 E KELLOGG DR, WICHITA, KS 67218-1607
(316) 685-2221
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
15-01253
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200569740B
—
KS
Enumeration date
08/25/2008
Last updated
01/21/2025
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