Provider Demographics
NPI:1114006665
Name:HEADLEY, MARY PATRICIA (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:HEADLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5838 EDISON PL
Mailing Address - Street 2:STE 100
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-5520
Mailing Address - Country:US
Mailing Address - Phone:214-460-3036
Mailing Address - Fax:
Practice Address - Street 1:5838 EDISON PL
Practice Address - Street 2:STE 100
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-5520
Practice Address - Country:US
Practice Address - Phone:214-460-3036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX508116363LF0000X
CA22257363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health