Provider Demographics
NPI:1811416951
Name:DOUGLAS, HEATHER MICHAELA (PA-C)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MICHAELA
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:5219 CITY BANK PKWY STE 35
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3545
Mailing Address - Country:US
Mailing Address - Phone:806-761-0360
Mailing Address - Fax:806-782-0097
Practice Address - Street 1:602 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-3364
Practice Address - Country:US
Practice Address - Phone:806-761-0566
Practice Address - Fax:806-744-7252
Is Sole Proprietor?:No
Enumeration Date:2017-09-10
Last Update Date:2021-02-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXPA11486363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant