Provider Demographics
NPI:1659871515
Name:EDMONDS, HEATHER KAY (LVN)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:KAY
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:KAY
Other - Last Name:TANKERSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LVN
Mailing Address - Street 1:2301 BRADFORD PEAR DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5688
Mailing Address - Country:US
Mailing Address - Phone:972-802-8294
Mailing Address - Fax:
Practice Address - Street 1:2301 BRADFORD PEAR DR
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-5688
Practice Address - Country:US
Practice Address - Phone:972-802-8294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-17
Last Update Date:2018-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231739164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse