Provider Demographics
NPI:1689018806
Name:HEISKELL, BRYAN KEITH (EP T, CNIMS)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:KEITH
Last Name:HEISKELL
Suffix:
Gender:M
Credentials:EP T, CNIMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 532620
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78553-2620
Mailing Address - Country:US
Mailing Address - Phone:956-216-7540
Mailing Address - Fax:956-216-7542
Practice Address - Street 1:712 N 77 SUNSHINESTRIP STE 23
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8897
Practice Address - Country:US
Practice Address - Phone:956-216-7540
Practice Address - Fax:956-216-7542
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXCNS4430246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic