Provider Demographics
NPI:1073527982
Name:HEARD, CONNIE JOAN (FNP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:JOAN
Last Name:HEARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:JOAN
Other - Last Name:WALLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:900 N ARMSTRONG AVE
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-2230
Mailing Address - Country:US
Mailing Address - Phone:903-465-2440
Mailing Address - Fax:903-465-2298
Practice Address - Street 1:900 NORTH ARMSTRONG
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020
Practice Address - Country:US
Practice Address - Phone:903-465-2440
Practice Address - Fax:903-465-2298
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX601808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP75181Medicare UPIN
TX84P490Medicare ID - Type Unspecified