Provider Demographics
NPI:1881570752
Name:HEADEN, KATIEN RENAY
Entity type:Individual
Prefix:
First Name:KATIEN
Middle Name:RENAY
Last Name:HEADEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 8TH AVE W APT 8
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2541
Mailing Address - Country:US
Mailing Address - Phone:717-680-1478
Mailing Address - Fax:
Practice Address - Street 1:243 8TH AVE W APT 8
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2541
Practice Address - Country:US
Practice Address - Phone:717-680-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-14
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant