Provider Demographics
NPI:1164617627
Name:KRISTY D. HEATLY, D.O., P.A.
Entity Type:Organization
Organization Name:KRISTY D. HEATLY, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEATLY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-864-2911
Mailing Address - Street 1:1900 SCENIC DR
Mailing Address - Street 2:SUITE 1128
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7724
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1900 SCENIC DR
Practice Address - Street 2:SUITE 1128
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7724
Practice Address - Country:US
Practice Address - Phone:512-864-2911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty