Provider Demographics
NPI:1407633977
Name:HALL, HEATHER R (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:HALL
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2203 W LAMPASAS ST STE 111
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:TX
Mailing Address - Zip Code:75119-5667
Mailing Address - Country:US
Mailing Address - Phone:972-875-6200
Mailing Address - Fax:
Practice Address - Street 1:2203 W LAMPASAS ST STE 111
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-5667
Practice Address - Country:US
Practice Address - Phone:972-875-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1135715363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily