Provider Demographics
NPI:1679907786
Name:COLLINS, HEATHER HARTLEY
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:HARTLEY
Last Name:COLLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYNDSEY
Other - Last Name:HARTLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:48168 KING ST
Mailing Address - Street 2:
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-1748
Mailing Address - Country:US
Mailing Address - Phone:870-672-1570
Mailing Address - Fax:
Practice Address - Street 1:48168 KING ST
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-1748
Practice Address - Country:US
Practice Address - Phone:870-672-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR9843126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant