Provider Demographics
NPI:1407320641
Name:HEISNER, MILLICENT MAE
Entity Type:Individual
Prefix:
First Name:MILLICENT
Middle Name:MAE
Last Name:HEISNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E HIGHLAND MALL BLVD STE 1A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3746
Mailing Address - Country:US
Mailing Address - Phone:512-320-1500
Mailing Address - Fax:512-459-1399
Practice Address - Street 1:408 W 45TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-3014
Practice Address - Country:US
Practice Address - Phone:512-320-1500
Practice Address - Fax:512-459-1399
Is Sole Proprietor?:No
Enumeration Date:2019-01-21
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140187363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care