Active NPI
Kjersten Heron, DDS
- Dentist
- Stronghurst, IL
National Provider Identifier
1376984120
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DE60371048
- Practice address
- 101 S Division St
Stronghurst, IL 61480-5033 - Phone
- (309) 924-2424
- NPI assigned
- Jul 9, 2013
- Last updated
- Mar 7, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DE60371048 | WA | Primary |
Addresses
Primary practice location
101 S Division St
Stronghurst, IL 61480-5033
Mailing address
4002 Ridge Way
Mount Vernon, WA 98273-9452
Phone (360) 424-9045
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160218000339 | WA | Order and Referring Only - Dentist | 2567767205 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Interoperability endpoints
- kjersten.otterholtdds.p29@direct.fhn-fqhc.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1373328000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457308800000",
"number": "1376984120",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4002 RIDGE WAY",
"city": "MOUNT VERNON",
"state": "WA",
"postal_code": "982739452",
"telephone_number": "360-424-9045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 S DIVISION ST",
"city": "STRONGHURST",
"state": "IL",
"postal_code": "614805033",
"telephone_number": "309-924-2424"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERON",
"first_name": "KJERSTEN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-07-09",
"last_updated": "2016-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WA",
"license": "DE60371048",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stronghurst, IL
- Brent Family Pharmacy Inc (Brent Family Healthmart Pharmacy)
- Henderson County Ambulance Service Inc (South Henderson County Ambulance Service)
- Henderson County Retirement Center, Inc (Oak Wood Estates Retirement Village)
- Henderson County Retirement Center, Inc.
- Henderson County Rural Health Center Inc (Eagle View Community Health System)
- Justine Link, ARNP
- Kersden Loretoni
- Jennifer Rose Carroll Reed, M.D.
- Bethany Renae Ruhl
- Mickey Robin Singh, D.M.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.