Individual
KRISTYN EMILY HEAGERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2999 MCMACKIN RD, MADISON, OH 44057-2330
(440) 428-1111
Mailing address
307 S EVERGREEN AVE, WOODBURY, NJ 08096-2739
(856) 686-4306
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
50.004808RX
OH
363A00000X
Physician Assistant
Primary
50.004808RX
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/15/2016
Last updated
06/06/2022
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