Provider Demographics
NPI:1356662118
Name:HEYNE, NICHOLAS GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:GREGORY
Last Name:HEYNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:580 DECKER DR STE 260
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-2306
Mailing Address - Country:US
Mailing Address - Phone:972-891-9217
Mailing Address - Fax:888-272-1333
Practice Address - Street 1:580 DECKER DR STE 260
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-2306
Practice Address - Country:US
Practice Address - Phone:972-891-9217
Practice Address - Fax:888-272-1333
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ85052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry