1699746594 NPI number — HEATHER J WELLMAN PA-C

Table of content: HEATHER J WELLMAN PA-C (NPI 1699746594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699746594 NPI number — HEATHER J WELLMAN PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WELLMAN
Provider First Name:
HEATHER
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699746594
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2425 HIGHWAY 121
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76021-5011
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-540-4477
Provider Business Mailing Address Fax Number:
817-540-5633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3537 S I 35 E STE 316
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76210-6870
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-205-4229
Provider Business Practice Location Address Fax Number:
940-243-3362
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA04349 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: PA04349 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8Y1402 . This is a "BCBS TEXAS NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5840300001 . This is a "MEDICARE DME" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TXB120923 . This is a "MEDICARE PART B - EFFECT 02/01/2011" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1699746594 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00954369 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 714812 . This is a "MEDICARE PART B" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 835N05 . This is a "BCBS TX 02/01/2011" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00684449 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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