| Traci Mae Heese, APRN | |
| 
					126 Missouri Ave, Glwach (attn: Sheila Ham), Fort Leonard Wood, MO 65473-8952  | |
| (573) 596-0417 | |
| Not Available | 
| Full Name | Traci Mae Heese | 
|---|---|
| Gender | Female | 
| Speciality | Nurse Anesthetist, Certified Registered | 
| Location | 126 Missouri Ave, Fort Leonard Wood, Missouri | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1598747578 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 110497 (Nebraska) | Secondary | 
| 367500000X | Nurse Anesthetist, Certified Registered | CR000714 (South Dakota) | Primary | 
| Entity Name | Phelps County Regional Medical Center | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1891766051 PECOS PAC ID: 2860391158 Enrollment ID: O20040106000405  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Traci Mae Heese, APRN 126 Missouri Ave, Glwach (attn: Sheila Ham), Fort Leonard Wood, MO 65473-8952 Ph: (573) 596-0417  | Traci Mae Heese, APRN 126 Missouri Ave, Glwach (attn: Sheila Ham), Fort Leonard Wood, MO 65473-8952 Ph: (573) 596-0417  | 
Samuel Alan Smith, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 4430 Missouri Ave, Fort Leonard Wood, MO 65473 Phone: 573-596-0035  | |
Dr. Sarah Elizabeth Bolin, CRNA, DNAP Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 4430 Missouri Ave, Fort Leonard Wood, MO 65473 Phone: 573-596-0417  | |
Mr. John Sebastian Wong, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 126 Missouri Ave, Glwach Attn Mcxp-ccs-cr, Fort Leonard Wood, MO 65473 Phone: 573-596-0417 Fax: 573-596-0524  | |
William Mark Collins, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 4430 Missouri Ave, Fort Leonard Wood, MO 65473 Phone: 573-596-0471  | |
Dr. Benjamin Althuisius, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 4430 Missouri Ave, Fort Leonard Wood, MO 65473 Phone: 573-596-0417  | |
Dr. Jeevan Bhatta, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 4430 Missouri Ave, Fort Leonard Wood, MO 65473 Phone: 573-596-0417  | |
Allan Anthony Bolido, CRNA, DNP Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 126 Missouri Ave, Fort Leonard Wood, MO 65473 Phone: 210-563-9539  |