Active NPI
Heidi Ruth Kallestad, ANP-C
- Adult Health Nurse Practitioner
- Irving, TX
National Provider Identifier
1457635633
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Adult Health Nurse Practitioner
- License
- 23483-A
- Practice address
- 3050 Regent Blvd Ste 400
Irving, TX 75063-5808 - Phone
- (214) 689-8067
- NPI assigned
- Oct 5, 2011
- 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 |
|---|---|---|---|---|
| Adult Health Nurse Practitioner | 363LA2200X | 23483-A | ID | Primary |
Addresses
Primary practice location
3050 Regent Blvd Ste 400
Irving, TX 75063-5808
Mailing address
24306 E 3Rd Ave
Liberty Lake, WA 99019-9656
Phone (206) 999-8229
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23483-A | ID | MD | Adult Health Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317772800000",
"number": "1457635633",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24306 E 3RD AVE",
"city": "LIBERTY LAKE",
"state": "WA",
"postal_code": "990199656",
"telephone_number": "206-999-8229"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3050 REGENT BLVD STE 400",
"city": "IRVING",
"state": "TX",
"postal_code": "750635808",
"telephone_number": "214-689-8067"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KALLESTAD",
"first_name": "HEIDI",
"middle_name": "RUTH",
"name_prefix": "Ms.",
"credential": "ANP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-05",
"last_updated": "2011-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2200X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Adult Health",
"state": "ID",
"license": "23483-A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irving, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.