Provider Demographics
NPI:1558506675
Name:HESELTON, LYNN VERONICA (RN,PMHCNS-BC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:VERONICA
Last Name:HESELTON
Suffix:
Gender:F
Credentials:RN,PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 LORINE ST
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-3434
Mailing Address - Country:US
Mailing Address - Phone:817-753-7070
Mailing Address - Fax:817-337-4224
Practice Address - Street 1:203 LORINE ST
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-3434
Practice Address - Country:US
Practice Address - Phone:817-753-7070
Practice Address - Fax:817-337-4224
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2009-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX737634364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health