Provider Demographics
NPI:1417999848
Name:HEDTKE, CAROL J (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:HEDTKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2535 CHARLOTTE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-3301
Mailing Address - Country:US
Mailing Address - Phone:940-387-7300
Mailing Address - Fax:940-387-1848
Practice Address - Street 1:2535 CHARLOTTE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3301
Practice Address - Country:US
Practice Address - Phone:940-387-7300
Practice Address - Fax:940-387-1848
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX675701363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXIN PROCESSMedicaid
TXTX135420OtherMEDICARE GROUP PTAN
TXTX135423OtherMEDICARE INDIVIDUAL PTAN
TXQ70213Medicare UPIN
TXTX135420OtherMEDICARE GROUP PTAN