Provider Demographics
NPI:1790075133
Name:HECK, KELLY (PA-C)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:HECK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17460 IH 35 N
Mailing Address - Street 2:SUITE 420
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-1243
Mailing Address - Country:US
Mailing Address - Phone:210-654-9300
Mailing Address - Fax:210-653-9302
Practice Address - Street 1:17460 IH 35 N
Practice Address - Street 2:SUITE 420
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1243
Practice Address - Country:US
Practice Address - Phone:210-654-9300
Practice Address - Fax:210-653-9302
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA07185363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical