Provider Demographics
NPI:1073080594
Name:CRITES, HEATHER (AGAGCNP-BC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:CRITES
Suffix:
Gender:F
Credentials:AGAGCNP-BC
Other - Prefix:MRS
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:CRITES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGACNP-BC
Mailing Address - Street 1:PO BOX 2078
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:TX
Mailing Address - Zip Code:76234-6156
Mailing Address - Country:US
Mailing Address - Phone:940-539-8128
Mailing Address - Fax:940-432-3640
Practice Address - Street 1:609 MEDICAL CENTER DR STE 1200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-3835
Practice Address - Country:US
Practice Address - Phone:940-539-8128
Practice Address - Fax:940-432-3640
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139279363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1073080594Medicaid
TX8RG692OtherBCBS