Provider Demographics
NPI:1760879530
Name:HEFNER, ERICA (RD)
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:
Last Name:HEFNER
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 SHARPVIEW LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-6057
Mailing Address - Country:US
Mailing Address - Phone:214-923-2884
Mailing Address - Fax:
Practice Address - Street 1:3117 SHARPVIEW LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75228-6057
Practice Address - Country:US
Practice Address - Phone:214-923-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5501-32438133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic