Provider Demographics
NPI:1689174518
Name:MATTHEWS, HEATHER ELIZABETH (RN, BSN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELIZABETH
Last Name:MATTHEWS
Suffix:
Gender:F
Credentials:RN, BSN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ELIZABETH
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST
Mailing Address - Street 1:14467 COUNTY ROAD 1125
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-6701
Mailing Address - Country:US
Mailing Address - Phone:903-707-0234
Mailing Address - Fax:
Practice Address - Street 1:14467 COUNTY ROAD 1125
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-6701
Practice Address - Country:US
Practice Address - Phone:903-707-0234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX915401163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse