Individual
KYLIE HEIM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1600 UNIVERSITY AVE, BOLIVAR, MO 65613-2578
(417) 328-1486
Mailing address
415 W ALDRICH RD APT 8, BOLIVAR, MO 65613-2770
(417) 693-2459
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2013022076
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2013022076
MISSOURI LICENSE
MO
Enumeration date
12/27/2016
Last updated
12/27/2016
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