Heather Elizabeth Polk, APRN

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

2019022989 Issued in MO

Practice address

200 Southland Dr
Sikeston, MO 63801-4403

Phone

(573) 472-1770

Fax

(573) 472-4050

NPI assigned

Jun 29, 2019

Last updated

Apr 14, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586822400000",
    "number": "1053973081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6738 STATE HIGHWAY 77",
            "city": "BENTON",
            "state": "MO",
            "postal_code": "637368238",
            "telephone_number": "573-313-2500",
            "fax_number": "573-313-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 SOUTHLAND DR",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638014403",
            "telephone_number": "573-472-1770",
            "fax_number": "573-472-4050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "421 Semo Dr",
            "address_purpose": "LOCATION",
            "city": "New Madrid",
            "state": "MO",
            "postal_code": "638691733",
            "country_code": "US",
            "telephone_number": "573-748-2592",
            "fax_number": "573-748-2673",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "941 Davis St",
            "address_purpose": "LOCATION",
            "city": "New Madrid",
            "state": "MO",
            "postal_code": "638691607",
            "country_code": "US",
            "telephone_number": "573-521-6787",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "109 E 5th St",
            "address_purpose": "LOCATION",
            "city": "Caruthersville",
            "state": "MO",
            "postal_code": "638301417",
            "country_code": "US",
            "telephone_number": "573-359-9803",
            "fax_number": "573-359-0990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "POLK",
        "first_name": "HEATHER",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-29",
        "last_updated": "2020-04-14",
        "certification_date": "2020-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MO",
            "license": "2019022989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI STATE BOARD OF NURSING",
            "identifier": "2019022989",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420077159",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David A. Pfefferkorn, M.D.
• Jacqulyn Christine Phelps, LPC
• Luke William Phillips
• Melissa Phillips
• Phoenix Place, LLC
• Salena Victoria Poston
• Michelle E Powers, LCSW
• Erika J Pratt, COTA
• Kristin Presley, FNP
• Shelly Ann Prevallet, MA, SLP

• Primary Care Nurse Practitioner in Sikeston, MO
• Providers in Sikeston, MO by specialty
• Primary Care Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.